Comments on: Medicine needs to get back to hands-on basics, rather than focusing on technology

By: stress management

stress management — Mon, 16 Nov 2009 06:10:07 +0000

I agree with the opinion of this post…

I personally believe getting back to basics only allows us to focus on what needs to be ordered as far as confirmatory tools go rather than the lazy ordering of the blanket battery of tests hoping to find the right diagnosis.

Nice article by the way, reminding me of the basics of clinical care and rational use of technology..

By: Betty

Betty — Mon, 16 Nov 2009 03:17:01 +0000

Interesting article. I just finished reading a book called "Time to Care" by Norman Makous, M.D. In his over sixty years in medical practice he has seen the phenomenal growth in the technologically effective methods used today. However, he believes that what has been lost is the very important and effective aspect of medicine that originates in the personal relationship between the doctor and patient. Professionals will find the case studies very valuable for application to their own medical training and continuing education.

By: Tex Bryant

Tex Bryant — Mon, 16 Nov 2009 01:08:47 +0000

As a patient I expect my healthcare to come from the experience of the physician aided by whatever technology he/she deems best. My primary care physician only relies on blood work for my physical. His experience and judgement supply the rest. My urologist yearly uses my PSA results but relies primarily on the rectal exam and his previous year’s notes. Whether his notes are electronic or not does not matter to me as long as he can access them quickly. I do however believe that it would be best if the results of my exams by my PCP and urologist were linked electronically. Thus, knowledge and wisdom sprinkled with some judicious use of technology seems best to me.

Looking from another perspective, one can see that technology has made a major impact on other business for the better. Take for instance, the office computer. For years, according to the Wall Street Journal, it did not improve the productivity of the average office. Today, however, it does make a big impact. I am sure that for healthcare there will be a gradual improvement in care with technology correctly used (as a support mechanism for the knowledgeable physician).

By: H

Sun, 15 Nov 2009 21:00:51 +0000

1. Doctor uses technology to diagnose instead of hands on examination.
2. Doctor’s hands on examination skills deterioate.
3. Patient becomes accustomed to technology for diagnosis.
4. Doctor does hands on examination to make diagnosis.
5. Patient feels uncomfortable with diagnosis and prefers technology to make diagnosis.
6. Doctor orders technology because patient will complain or sue if diagnosis is wrong.
7. Doctor grumbles that patients are the driving force behind unnecessary testing.
8. Lawmakers don’t see the value of hands on examination and continue to provide more funding for technology.
9. Doctors continue to rely on technology.
10. Patients continue to insist on technology.
11. Health care is expensive.

By: Alchemipedia

Alchemipedia — Sun, 15 Nov 2009 18:26:40 +0000

The art of diagnosis is essentially an iterative process involving the generation of hypotheses (differential diagnoses) which are then tested through further history taking, further examination and selected relevant investigations. The medical hypothes(is)es are then either refuted or tentatively supported by the facts, with further iteration occurring. The most useful initial tools still remain the history and examination.

In health care systems with limited resources, the requesting of routine batteries of tests leads to increased costs and delays in diagnosis and appropriate management. Using the example of a CT scanner, if the capacity is 30 scans per day, and 20 of those are unnecessary then there will be delays in obtaining appropriate diagnoses for those patients where the CT is really needed.

Limited medical resources are real issues in most health care systems, including amongst the uninsured in the US.

At least historically, it was felt that when doctors from Commonwealth countries went to the US for postgraduate fellowships then their clinical examination skills deteriorated. The culture of using tests as a replacement for a careful history and examination is likely partly to blame for this.

By: Paul MD

Paul MD — Sun, 15 Nov 2009 02:54:05 +0000

McCoy also had that cool salt shaker that he would wave over the chest to cure whatever it was that ailed ya. Next to the tricorder (circa 1968 RCA transistor radio), its what I’m talk’n bout.

By: Anonymous

Anonymous — Sat, 14 Nov 2009 20:54:51 +0000

If the blood pressure was off in the other arm, won’t the surgeon get a CT scan to confirm the extent of the dissection, before taking the patient to the OR?

By: Doc99

Doc99 — Sat, 14 Nov 2009 20:20:28 +0000

Damn …. You’re right of course. But I was actually holding out for Leonard McCoy’s Tricorder. Physical diagnosis, how quaint!

By: Jenga

Jenga — Sat, 14 Nov 2009 18:36:06 +0000

I agree with Marcus. It would not have eliminated the need for the CT. I don’t know a single CVT surgeon that would open someone’s chest based on a BP reading and I hope I don’t meet one. It might have saved the guy, but that is a big if. On a side note, the correct treatment would have been vastly more expensive. Surgery ain’t cheap which kind of goes against the gist of the article.

By: jsmith

jsmith — Sat, 14 Nov 2009 16:12:15 +0000

The author is correct of course, but he’s swimming against the tide. Good luck with that. America is a country of mass techno-delusion.
Some technology is great–CTs and MRIs and antibiotics comes to mind–when used appropriately. Some not so great.
My favorite recent example of medical techo-idiocy is the vaunted Electronic Health Record. Rarely helpful, usually useless, frequently worse than useless, yet coming soon to a practice near you.