Humans and technology in healthcare – Clinical Method comes first!
Eminent physician and medical educator, Dr. Marshall Wolf – on the primacy of Clinical Method over high-tech diagnostic tests for patient evaluation:
One of the goals in this project is to highlight the primacy and the value of humans in medicine – to provide the antithesis to growing public’s perception that doctors have become servants of technology and nothing much else. How do you think about physician’s place in current technology-driven world? How to promote the value of humanity and compassion in modern medicine, and to get the public to understand that value? Well, I think you’re bringing two issues: One, in terms of the human aspect, I think it’s important to pay attention to what the patient’s going through emotionally when you deal with them. The fact that they may be frightened, they may have a large amount of denial in dealing with their problem. The second issue is the balance between old-fashioned clinical medicine and new technology. I don’t see those as competing, I think, as somebody who’s been around a long time, I’ve seen new science and technology provide for patients something that I couldn’t have provided when I was starting in medicine, and curing them or helping them. I do think that the important thing is… Physician’s first job, when a patient comes in, is to decide, “Is the patient sick or not?” Sometimes patients are worried about something that isn’t too important, it’s not a health hazard. And you have to decide that. Then, once you’ve decided that they have a problem, you have to use history to try and figure out, what might be going on. I like to talk about the Clinical Method, which is: The patient comes in with a complaint, you listen to their story, you then have a several hypotheses about what might be going on. You then talk further to the patient to try to define those hypotheses. Based on your hypotheses you do a focused physical [examination], which may change your hypotheses. And then, based on your history and physical [exam], you say, “I’m worried about A, B and C.” At that point, this is a time when you involve technology to try and figure out, “Is it A, B or C?” And I think the problem is, a lot of people start out – the patient gives the chief complaint and then they immediately start the technology. That’s the wrong way to do things. It is backwards. It’s really thinking first, and then using the gadgets later… Yeah, so if you’re trying to figure out if the patient has pneumonia or chest wall pain, an X-ray may be useful as a physical exam doesn’t answer the question. For that problem usually you don’t need a CT or MRI. And often, if you do physical [exam], you can figure out if they have a pneumonia, without chest X-ray.