Good Medicine IS Cheaper Medicine

On July 8, the Canton Repository published a syndicated article about the missing clinical acumen of physicians who are increasingly relying on testing without the proper traditional listening to patients and conducting a brief physical examination.

We learned from medical school that listening to the patient yields a diagnosis 80% of the time, and when you add proper physical examination you reach a diagnosis 90% of the time. Testing is done to confirm or refute.

I could not agree more with the content and the disturbing stories. I can count dozens of cases in my own experience where mishaps could have been avoided by simply following “bedside basics.”

One such case was a 56 year old woman who went to her gynecologist complaining of vaginal itching. The nurse practitioner who saw the patient on behalf of the doctor diagnosed her with menopausal symptoms, (vaginal dryness) and gave her a prescription of estrogen without doing a physical examination. The prescribed treatment did not help.

A few weeks later the patient went back with the same symptoms unrelieved. Again, the nurse practitioner without examining her told her she had herpes and gave her a prescription. The patient got very upset. Being a devout wife, she accused her husband of infidelity, giving her the sexually transmitted disease. The husband, becoming doubtful of the care and diagnosis, arranged for his wife to be seen by a gynecological oncologist. As expected, the new physician examined her and discovered a grapefruit-sized mass in her vagina, a malignant melanoma. He performed the required surgery and referred her to Gabrail Cancer Center for further management. Unfortunately, by that time it was too late for a favorable outcome.

Medical technology has diminished the value of the art of medicine and bedside acumen. The result is that patients are getting hurt, and their care is becoming more expensive. Employers who care about their employees and of course pay the bill are becoming increasingly involved in assuring that their employees and covered dependents get the best care available. They are providing better care at lower cost. As always, Good Medicine is Cheaper Medicine.