We’ve all been there. It often starts with some kind of recurring pain or dull ache. We don’t know what’s causing the pain or ache. During the light of day we tell ourselves that it’s nothing. But at 3:00am when the pain wakes you, worry sets in: “Maybe I have cancer or heart disease or some other life-ending ailment.” The next day you make an appointment to see your doctor.
So now you’re sitting in the exam room explaining this scenario to your doctor. Based on your previous experience, what’s the first thing your doctor would do?
A. Order a battery of tests and schedule a follow-up appointment.
B. Put you in a patient gown and conduct a thorough physical examination, including asking you detailed questions about your complaint before ordering any tests.
If you answered “A,” you have a lot of company. A recent post by Robert Centor, M.D., reminded me of yet another disturbing trend in the doctor-patient interaction. The post, entitled “Many doctors order tests rather than do a history and physical,” talks about how physicians today rely more on technology for diagnosing patients than their own “hands-on” diagnostic skills — a good patient history and physical exam, for example.
Prior to the technology revolution in medicine over the last 20 years, physician training taught doctors how to diagnose patients using with a comprehensive history and physical exam. More physicians today are practicing “test-centered medicine rather than patient-centered medicine.” Medical schools focus on teaching doctors to “click as many buttons on the computer order set as we possibly can in order to cover every life-threatening diagnosis.” The problem is that medicine is still an imperfect science, and technology is not a good substitute for an experienced, hands-on diagnostician.
The results of this move to “test-centered medicine” include more unnecessary tests ordered, patients exposed to unnecessary risks (radiation, anxiety, etc.), and healthcare costs going up.
Get Your Physician To Listen Or Find A Physician Who Knows How To Listen
Sir William Osler (1849-1919), who’s considered the “most influential physician in history,” believed that the best diagnosticians were those who listened to their patients. The following quote attributed to Osler says it best: “Listen to the patient — he (or she) is telling you the diagnosis.”
So the next time you’re sitting on the exam table, before your doctor can interrupt you, present an organized history of your complaint. Ask your doctor to examine you before referring you for X-rays or lab tests. If your doctor can make the case for tests after he or she has heard you out — fine. This way you can be more likely of getting the correct diagnosis.
*This blog post was originally published at Mind The Gap*