Treat the patient, not the CT scan, says Abraham Verghese, physician and professor. Along with Atul Gawande, Verghese is to me one of the sane, honest and disturbing voices on medical ethics and practices.
In my experience, being skilled at examining the body has a salutary effect beyond finding important clues that lead to an early diagnosis. It is a ritual that remains important to the patient.
As someone who has gone through a major spine surgery and just this week seen my mother through a surgery for fractures in her hip, I agree completely with Verghese. The best technology and the most efficient surgical methods cannot make up for the ten minutes the physician spends by your bed-side, answering questions and addressing your concerns even before they are voiced.
The experienced general physician – the Ho Ho Santa Claus medical equivalent who advices you to take a brisk walk and some vitamins for all ailments – is becoming outdated now. It is the age of super-specialization (which works fine – as the Gawande makes in The Velluvial Matrix). But that also means that physicians who are able to see the patient as a whole rather than a trouble organ or limb are becoming rare. And therefore, the heavy dependence on tests and technology, rather than old-fashioned personal analysis.
More – Rituals are about transformation, the crossing of a threshold, and in the case of the bedside exam, the transformation is the cementing of the doctor-patient relationship, a way of saying: “I will see you though this illness. I will be with you through thick and thin.” It is paramount that doctors not forget the importance of this ritual.
A must-read.
Here is something I had written long ago on Abraham Verghese’s moving My Own Country.
Hi. I couldn’t agree with you more. Doctors are losing their ability to conduct proper clinical examination. As you say, look at the patient as a whole – as a person. They are not just a sum of body parts. Last year was a tension filled one on account of my mother’s health. And thats when I got a realisation of this. It was finally a physician – who lectures at the medical college and works with a government hospital who was able to correctly diagnose her problem and direct us an appropriate line of treatment.