The Doctor Will Not See You Now
The traditional physical exam is fast becoming obsolete, in part due to technology and in part the result of the declining examination skills of new doctors. Some of the consequences are interesting.
A number of doctors, including KevinMD and DrRW, have commented on Dr Abraham Verghese’s recent article in the New England Journal of Medicine concerning the loss of clinical examination skills, and what to do about it, if anything.
Current medical economics requires Doctors to see more patients, leaving little time for any in depth analysis and discussion to be meaningful. It may well be that one on one physical exams will go the way of the Great White Buffalo, but it’s not clear what, if anything, will replace it.
Not surprisingly, a growing number individuals and organizations, not all in the government, see technology as The Answer to health issues in general, particularly as they relate to costs. With medical information increasingly available on the WWW, and google searches getting more relevant, seeing technology as a quick fix is understandable.
Abstracting meaning from paper charts or Electronic Medical Records without validating them against a real patient/customer is something that google and its kin will be doing better and faster as time goes on.
But (always one of these), technology has a way of becoming an end in itself, easily demonstrated by the failure of initiatives like HL7 to standardize health information, the growing complexity of coding systems such as ICD9 and ICD10 that makes it easier to withhold treatments and shortchange Doctors. And then there are the increasing demands of bureaucrats, whether in government or at insurance companies, for more and more forms tailored to their particular and parochial workflows.
Left out of all this is the concerns of patients/customers, as the see that they are getting much less attention from their Doctors, who are spending more time with their own problems and techno whiz-bang.
Doctor Verghese suggests that, perhaps, Doctors should spend less valuable patient/customer face time on clinical minutiae, and instead focus on more rapport and empathy. It’s not clear how that would be coded, or where the time would come from.
Patients/customers will have to take a more active role in their health management, facilitated by more and better tools. Doctors should take care that their value add doesn’t become perceived as marginal to these new aids and holistic perspectives outside the guild.
A Word From Our Sponser
FutureWare’s 
Personal PrescriptionTracker Is A Secure Easy Way To Track Your Family’s Prescriptions, Supplements And Vitamins!
Tags: doctor workload, electronic medical records, health care, hl7, medical technology, physical exams, primary care physicians