Are doctors clinicians or technocrats

Dear Prof Dr. Andrew

Thank you for agreeing with me.

A lot of diseases are Iatrogenic, caused by all these annual medical check-up, unnecessary investigations, unnecessary medications prescribed by the doctors themselves.

Let me give my frank view who makes a competent doctor.

By merely taking the medical history of a patient, and asking him a lot of questions, a competent doctor with very good clinical acumen would already be able to analyze and differential diagnose a patient’s illness without resorting to all those unnecessary and expensive lab tests, imaging and scans which to me all these images are just shadows on a film with no definitive diagnosis.  I only agree lab examinations provide some data of blood levels of a pathology which is not possible with just clinical examination

Thus,  I am not saying lab support is unnecessary. What I am trying to drive home to doctors is that these  blood, urine and serological-immunological tests  should be reserved for difficult cases where the clinical presentations  may mimic other conditions or disorders sharing the same signs and symptoms unless the signs and symptoms are presented as a group typical of the classical features (syndromes) of a specific disease.

In which case lab tests (biochemical, serological, haematological, microbiological, nutritional, molecular-biological assays…etc., etc.) may be necessary to confirm, or to monitor the progression of a disease or a treatment. These tests are just adjuncts to clinical examinations.

A physical examination is thus extremely important to diagnosis besides history taking. What about doctors who work in rural environment and among primitive societies where sophisticated lab technology and molecular-biological assays are completely not available? They will be sunk if they do not have the clinical skill

History taking and physical examinations are all non-invasive. They are cheap, reliable, and traditionally used since medicine was practiced by all cultures and civilizations long, long before all these sophisticated medical technology was invented by scientists in research laboratories to help the doctors.

History taking, listening carefully what a patient tells you (the patient is our mentor) and just some basic but relevant clinical examinations would already give a doctor with competent clinical acumen  almost 90 percent accuracy in his diagnosis without resorting to all those scans and elaborate lab investigations which are just  adjunct to support a diagnosis.

 I only respect a clinician who is a good diagnostician using  just his hands, ears, and eyes to assess (palpate, percuss and auscultate) without using all those unnecessary lab examination as “diagnostic clutches” This is my frank opinion on who makes a competent  clinician and a first class diagnostician

   

Just ask ourselves how did doctors diagnose well before all these sophisticated medical technology was developed by the scientists to help the doctors?  Yet these “ancient” doctors can make brilliant diagnosis, and also document and publish papers to describe the features, pathology, causes, outcome and prognosis of any disease s so accurately and so beautifully and have their description  published in standard textbooks of clinical medicine which even today modern doctors and medical students  read, learn and get their training

They  all learn from  these books written by doctors in the 18^th Century where all these lab tests and imaging technology were not available? They must be genus to describe, diagnose and treat disorders almost the same way doctors do today except they do not need lab tests 

The text books they wrote,  such as Sir Stanley Davidson textbook on The Principle and Practice of Medicine is not much different from the current Oxford or Price Textbooks on Medicine (just to quote two examples among hundreds of modern medical textbooks)

In fact the modern textbooks merely expand existing chapters of the older books without altering the  original  content. How did these “non-technological” doctors describe the pathology and diagnosis so many diseases  so accurately decades before all these lab tests, radiological and histology examinations became available? They must be genus, and we need to salute them.  Currently doctors need technological clutches to help them diagnose.  They “must” have all those lab data, without them they are sunk.  

 Ask ourselves this question that even today; despite impressive medical imaging and molecular medical tests, just history taking and physical examination remain indispensable in many contexts. Before the 19th century, the history and physical examination were nearly the only diagnostic tools the physician had, which explains why tactile skill and ingenious appreciation in the exam were so highly valued in the definition of what made for a good physician.

Even as late as 1890, the world had no radiography or fluoroscopy, only early and limited forms of electrophysiologic testing, and definitely no molecular biology to help doctors as we know it today.

Ever since this peak of the importance of the physical examination, reviewers have warned that clinical practice and medical education need to remain vigilant in appreciating the continuing need for physical examination and effectively teaching the skills to perform it; this call is ongoing, as the 21st-century literature shows.

To me, this is what makes a very competent, and an extremely skillful doctor who is an excellent diagnostician by using just his eyes, ears, hands and his brilliant analytical brain to differential diagnose even a mixture of complicated disorders. Can we do that?   

The rest who depends on lab and medical technological support are all brainless robots

This is my view Professor Dr.  Andrew.  I am sure you agree as an eminent medical-surgical specialist from prestigious John Hopkins School of Medicine

A Non Robot