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How Good Is Your Doctor At Diagnosing You?

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. Read more »

*This blog post was originally published at Mind The Gap*

Patients As Partners

The famous late 19th and early 20th century physician, Sir William Osler, said that “a physician who treats himself has a fool for a patient.” How would he have felt about patients diagnosing and treating themselves? Would he have written in support of the Journal of Participatory Medicine or against it? I also wonder how he would have practiced medicine in the “information age” when many of our patients present with a diagnosis already made, right or wrong.

I recognize that bringing Dr. Osler into a discussion set in the information age is, perhaps, anachronistic. Yet I believe he still has something to teach the 21st century on the topic of patient participation. When he advised that “the first duty of the physician is to educate the masses not to take medicine,” he offered one of the earliest lessons on a physician’s role as educator.

He also said: “The great physician would treat the patient with the disease while the good physician would treat the disease.” For me, this marches lock-step with the reality of today’s patient as consumer and active participant in the doctor-patient relationship. Simply put, it is impossible to separate the patient from a pre-conceived and often well-researched opinion — correct or not. So to treat the “patient with the disease” requires me to think of my patient as an intellectual partner. Read more »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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