Wednesday, September 9, 2009

Remembering the Human Touch

One of our Associates recently sent me this story, written by a physician who urges doctors to return to the healing power of touch, and cautions that the rush to use the latest high-tech diagnostic tools often ignores the intrinsic value of a physical exam.

As I have often said, one of the reasons for the skyrocketing cost of health care is not misuse, but overuse. The author of the article avoided costly tests (ultrasounds, CAT scans, MRIs) to diagnose the patient’s condition by merely touching her, but this was not her first line of thought.

It also impresses upon me the importance of family practice physicians and physician extenders, who—it seems to me—generally have a much greater tendency to rely on their diagnostic skills.

We constantly hear the excuse that physicians are worried about liability, and therefore utilize more technology both in lab and radiology to, in essence, protect themselves from unmerited malpractice suits. This is why we have been so clear that tort reform must be included in national health care reform. I will not rehash the CHRISTUS experience with tort reform in Texas in this post, but feel free to visit a previous post on tort reform to learn how successful we believe it has been thus far.

If we as physicians could return to utilizing more physical diagnosis and not worry about liability before jumping to the use of technology, we would go far in reducing overuse and misuse in the health care industry.

The case Dr. Castro described in her article demonstrates that hypoglycemia is the most common cause for diabetic confusion (which is quickly diagnosed from confused dialogue with a sweaty patient). This patient could have been sent for a CAT scan or MRI, during which she could’ve suffered ongoing and probably permanent brain damage from her persistent low blood sugar.


Dan House said...

This physicians story is also the story of anyone whom considers themselves as a professional. As an Admitting Director I constantly deal with the internal struggle of trusting our reports upon review or investing in the validation of the information. This validation (or placing your hands on the patient)can save the hospital money by early intervention (identifying the patient's true condition). In most cases we find no difference between the reports and what's happening in the registration areas. This gives the tempatation to skip this step. This is what seperates mediocrity from excellence. This does not apply to just physicians, but to all of us.

Anonymous said...

"Physician extenders"?? What a derogatory term for health care professionals, all of whom (besides PAs) are independently licensed and capable of providing top notch care for patients without the supervision your term implies. Our health care system needs every qualified provider to practice to the full extent of their licensure to improve access and quality.

Dr. Tom said...

Thank you for your comment and pointing that out. I would not otherwise have realized that some might find the term “physician extender” derogatory, because I have heard it used across the industry to describe physicians’ assistants and others who work under the supervision of a physician but have the ability to do “independent” activities.

I did not mean it to communicate any kind of disregard for providers like midwives and physicians’ assistants, or the many other talented professionals who provide high quality care to patients across the U.S. every single day. In fact, I meant to communicate that these practitioners will be absolutely necessary if we are to provide high quality primary care to every American! If you’d like to read more of my thoughts on this subject, please see this post from Dec. 3, 2008: