Tuesday, July 29, 2014
Inquirer Daily News

Our Doctors Are Becoming Technocrats Instead of Healers

A colleague of mine saw two different specialists in another state for a serious problem. Both doctors told her they did not feel comfortable treating her, and both referred her to a very prominent specialist in Philadelphia. She asked me to accompany her, listen carefully and take notes.

Our Doctors Are Becoming Technocrats Instead of Healers

A colleague of mine saw two different specialists in another state for a serious problem.  Both doctors told her they did not feel comfortable treating her, and both referred her to a very prominent specialist in Philadelphia.  She asked me to accompany her, listen carefully and take notes.

We went to the office and were immediately told that the very recent x-rays she brought with her were “not adequate” and she had to have another set of images at this facility.  She complied.  We were then brought into an examination room and a resident examined her without disrobing her.  The examination was very cursory and he did not visually inspect or palpate the area of concern.  In addition, he failed to review her extensive medical history. He then gave her a series of diagnoses and said that he could refer her to additional specialists. 

The attending physician then entered the room.  He did not wash his hands and was accompanied by a young woman whom he failed to introduce to us.  He also never asked the patient to disrobe, did an even more cursory examination and rattled off a series of diagnoses that were very different from the diagnoses given by the resident and the two referring physicians in another state. 

When he left the room, my colleague was in tears.  I asked the nurse if the attending physician could come back in and she said that he was busy seeing other patients.  I told her that we would wait.  After a few minutes, he returned to the room, obviously annoyed at being called back in and questioned.  I told him that I was a physician and we were confused and read him back verbatim the resident’s series of diagnoses and his.  He told us that he was the attending and the resident was only a resident.

I wish this experience were atypical, but, unfortunately, it is not.  Let’s look at some of the more serious issues it raises.

First, why were the images repeated?  This generated unnecessary costs and radiation exposure for the patient.

Second, why did we have to waste our time with the resident if his diagnoses and his history taking and physical examination skills were inadequate?  I understand that it is critical that residents interact with patients as part of the learning process, however they need supervision, mentoring and feedback.  If this does not occur, deficiencies in their skills will be perpetuated. Why did the resident provide us with a series of diagnoses without speaking to the attending physician?

Third, why did the attending physician not disrobe the patient, why did he do an extraordinarily inadequate history and physical exam, and why did he then demean his resident in front of the patient.

This episode illustrates many disturbing issues with our modern medical care. I loved my career in medicine and always prided myself on being an excellent clinician and taking the necessary time to do justice to every patient I encountered. However, I am depressed and disturbed at the way modern medicine is too often practiced.  Most worrisome is my suspicion that the great cerebral teachers of medicine (those who relied on history and physical examination skills and who made extraordinary efforts to avoid “sins of omission”) have either retired or died and that the teachers of our new physicians are increasingly technocrats who were never themselves taught the art needed to make a good physician.  This could become a self-perpetuating phenomenon.

Before we can truly reform health care, the system must heal itself.

-----

Have a health care question or frustration? Share your story »

Read more of The Field Clinic »

Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
About this blog

The Field Clinic reports and analyzes health care laws, government policies, and political trends that are transforming the care we receive and the way we pay for it. Read more about our panel of bloggers here.

This blog is produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente. Portions of this blog may also be found on Inquirer.com and in the Inquirer's Sunday Health Section.

Follow the Field Clinic on Twitter.

RSS feed.

Robert Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson School of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson School of Population Health
Mark V. Pauly, Ph.D. Professor of Health Care Management, Business Economics and Public Policy at The Wharton School
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Donald Schwarz, MD, MPH Deputy Mayor for Health & Opportunity and Health Commissioner for the City of Philadelphia
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
Krystyna Dereszowska A third-year law student concentrating in health at Drexel
Latest Health Videos
Also on Philly.com:
Stay Connected