HEALTH CARE – LOST ART?
Saturday, October 16th, 2010 7:26 AM by Christopher Gregory
Dr. Bob Kramer is a physician I admire and value as a colleague in our efforts to spread the DocOnomics mission. I consider Dr. Bob to be a doctor’s-doctor – a lot of lucky kids grew up with him as their pediatrician.
He and I have spent many hours talking about his views on the practice of medicine and what has happened to cause so many of the problems being experienced today, i.e., soaring costs, depersonalization, erosion of physician morale, and medical education to name a few. An interesting article appeared in one of my journals the other day that underscores exactly what Dr. Bob has been saying all along.
This recent NY Times article was about Dr. Abraham Verghese, the senior associate chairman for the theory and practice of medicine at Stanford University. At Stanford, Dr. Verghese is on a mission to bring back something he considers a lost art: the physical exam. The old-fashioned touching, looking and listening — the once prized, almost magical skills of the doctor who missed nothing and could swiftly diagnose a peculiar walk, sluggish thyroid or leaky heart valve using just keen eyes, practiced hands and a stethoscope.
He is out to save the physical exam because it seems to be wasting away, he says, in an era of CT, ultrasound, MRIs, countless lab tests and doctor visits that whip by like speed dates. He asks who has not felt slighted by a stethoscope applied through the shirt, or a millisecond peek into the throat?
Some doctors would gladly let the exam go, claiming that much of it has been rendered obsolete by technology and that there are better ways to spend their time with patients. Some admit they do the exam almost as a token gesture, only because patients expect it.
Medical schools in the United States have let the exam slide, Dr. Verghese says, noting that over time he has encountered more and more interns and residents who do not know how to test a patient’s reflexes or palpate a spleen. He likes to joke that a person could show up at the hospital with a finger missing, and doctors would insist on an M.R.I., a CT scan and an orthopedic consult to confirm it.
So why is this happening? Why do my memories fade of Dr. John Wyatt, my friend and my family physician for so many years in Chicago, or Dr. H. Seid Ashraf, my son’s pediatrician in Milwaukee who was there for my child during so many years of health challenges? They were both primary care doctors who took charge of our health, and did a damned fine job of seeing us through many trying times.
It’s like Dr. Bob says – medicine has gone “high tech, low touch”. We now prefer numerous tests and procedures that have supplanted the touching, listening and observing skills of the fine doctors we have – because they aren’t given the time to spend with patients and because so many operate in fear that missing anything will end their careers.
That, readers, is why Dr. Bob and I believe so strongly in the cause and the necessity to maintain primary care medicine at the forefront of our healthcare delivery systems. That is why Clayton Christensen at the Harvard Business School talks about the patient-centered intuitive core of medicine and the crisis we are experiencing because of the declining number of primary care physicians who must play a key role in the positive disruptions needed in health care.
There are primary care doctors in Dallas, Texas that are working together to do great things. In their strength of numbers, they are taking care of the needs of a population of citizens who require good, affordable care. We’ve written about the Jefferson Physicians Group, and hope that those efforts can proceed everywhere.
We need to give our front-line physicians the opportunities to best use the tools that are so important – hands, eyes, ears and the time to employ those skills. We need to reimburse them fairly and adequately so they don’t have to rush through more and more patients each day just to keep their doors open. And we need to reduce the fear factor every doctor carries around, that the lawsuit will wipe them out.
If we do that, we’ll solve some of the problems with exploding costs, an unhealthy population and the dwindling numbers of primary care physicians just when our needs are so great.
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Here is a great post about the lost art of the Physical Exam in our current Fee for Service system, lost in a sea of interventions and tests. The diminishing time primary care docs have for each visit is an exacerbating factor. This is Chris Gregory from Doconomics who mentions our Advisory Board Member Dr Bob Kramer and his quest to enable physicians to return to high touch practice. Must Read Post...
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