When I was a young boy, my father, who practiced medicine from 1950 to 2006, would take me on hospital rounds with him. He taught me a lot about interacting with patients, physical diagnosis and disease states and their treatments. But perhaps the greatest and most enduring thing he imparted was to always have an “index of suspicion.”
It was his former teacher, the legendary Isidore Snapper, MD, who taught him the same. Dr. Snapper, former doctor to the Dutch royal family and a prisoner of war under the Japanese in WW 2, was arguably the greatest diagnostician of 20th century Western medicine. He was the master of “bed-side medicine,” a combination of art and science that relied mostly upon being an attentive medical detective. He taught his students that everything about the patient, including the way he/she looked, talked, walked and even smelled, offered clues to diagnose and treat disease. But to get to even that point of diagnostic sophistication required the clinician to care enough, pay attention enough and have discipline sufficient to entertain all the possible reasons for what was evident from physically examining his subject.
I’m afraid this valuable time- and energy-consuming practice is being lost. Today, doctors’ attentions are diverted to what the health care industry glibly calls “metrics,” a garbage-bag term that encompasses everything from vital signs, lab results, admission rates and outcome statistics to number of days in hospital, infection rates—you name it. Doctors today, who are taught to rely on diagnostic studies and lab results more than they ever did before, have largely lost the art of diagnosis that Snapper so brilliantly advocated and taught.
A visit to your doctor is more likely now to be a hurried affair, with your healer clacking away at a computer while you talk about your problems. Larger patient volumes, a by-product of our aging and sicker populace, is partly to blame. But so too is the reliance on test results and a deficient focus in medical education, so different now than in my dad’s heyday.
Does this mean that people get less effective and satisfying treatment? I’m not sure. I can’t seem to find evidence one way or another. But I will tell you this: Interventions such as CT scans, X rays, blood tests and many more too large in number to note are driving costs up and do come with side effects. In many cases, a shotgun approach to diagnosis, in the worst scenario, replaces actually examining and listening to the patient. With this, the essential index of suspicion, that extra-mile of thought and evaluation of the physical and spoken evidence a patient gives, is often non-existent. After all, physicians of the later generation were raised to have instant gratification; more so than their predecessors. Also, they have, clearly, a shorter attention span. This is self-evident; just look around you.
What can you, as patient, do? Seek out a doctor who listens. Prepare your complaints and story carefully. Show the doctor, with your finger, where you ail or hurt, the nature of the pain or symptom, how long it’s been bothering you. Ask specific questions. Short of all that, ask the doctor to lay hands on you. But don’t be surprised if you get a strange look. Doctors like Snapper are rare these days.
