Saturday, February 03, 2007
real doctors must tap and thump
Abraham Verghese in Texas Monthly:
I was taught to tap and thump my patients and listen for the sounds of sickness and health. But this is fast becoming a lost art, and that’s bad for everyone.
When I travel as a visiting professor to teaching hospitals, I have the distinct feeling that the patient in America is becoming invisible. She is unseen and unheard. She is “presented” to me by the intern and resident team in a conference room far away from where she lies. Her illness has been translated into binary signals stored in the computer. When I ask a question about her, the intern’s head instinctively turns to the computer screen, like a pitcher checking first base. I gently insist we go to the bedside, but that is often a place where the team is no longer at ease. I realize what has happened: The patient in the bed is merely an icon for the real patient, who exists in the computer. How strange this is! When one knows how to look, the patient’s body is an illuminated manuscript. Indeed, in an elderly patient with a double-digit “problem list” that scrolls off the screen, only at the bedside does one understand which problem is most important. As my brother-in-law would put it, “You have to kick the tires.”
I am no economist, but even a landlubber on a sinking ship is entitled to make observations about the rent in the hull that is about to alter his fate: The present crisis in American health care is only secondarily a fiscal one; the real crisis is that the “art” of bedside diagnosis at which a previous generation excelled has died with the next. Personal-injury lawyers allow us the wonderful excuse that we order batteries of tests because we are practicing “defensive” medicine. The truth is that even without the threat of malpractice, we would still need just as many CAT scans and echocardiograms as we do now. We know no other way. Take away our stud finders and we can’t hang a picture. We are like owners of playerless pianos asked to entertain during a blackout: Our fingers and ears may be intact, but we can no longer play or percuss.
Link to The Center for Medical Humnaities and Ethics started in 2002 by Dr.Verghese.
Thanks to Vimala Mohammed.
Posted by Sughra Raza at 11:27 AM | Permalink