Thursday, February 8, 2007

"I have the distinct feeling that the patient in America is becoming invisible"

Posted By on 02.08.07 at 06:31 AM

Dr. Abraham Verghese writes in the Texas Monthly (by way of 3 Quarks Daily): 

"In the past 25 years, I have taught hundreds of medical students the four classic steps in the physical examination: inspect, palpate, percuss, and auscultate. Their eyes sparkle. This is the way they imagined themselves: semioticians at the bedside, reading the signs to find the varmint in the patient’s body. Alas, a shock awaits the students when they finally arrive on the wards in the third year of medical school, their pockets laden with reflex hammers, tuning forks, ophthalmoscopes, otoscopes, penlights, and stethoscopes, only to discover that the ebb and flow of the modern hospital centers on MRIs, CAT scans, echocardiograms, angiograms, and myriad lab tests. Often, interns and residents have so little faith in bedside diagnostic skills that, as one student told me, 'a man with a missing finger must get an X-ray before anyone will believe he has only four.'...

"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."

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