As patients put to test, docs losing clinical expertise

1. As patients put to test, docs
losing clinical expertise
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2. Contd…
You go to the doctor expecting him or her to listen to your description of your
ailments and examine you physically . Instead, you are ordered to go in for one test
or the other. It is only on the basis of these tests that the doctors finally scribble a
prescription. This is a reality that many in the medical fraternity are well aware of
and worry about.
“Young doctors are losing their clinical skills due to overdependence on diagnostic
findings,“ said Dr Girish Tyagi, registrar of the Delhi Medical Council. But even more
dangerous is the possibility that diagnoses based purely on tests come are
accepted without cross reference to clinical findings. Dr Krishnamoorthy Srinivas, a
neurologist, recently wrote in the medical journal `Neurology India' that the
dependence on MRI findings rather than a clinical examination of a patient had the
potential of leading to misdiagnoses and excessive treatment.
“The new slogan relevant today is: Please listen to the patients because they are
trying to tell you the diagnosis,“ Srinivas opined.
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3. Contd…
Tyagi felt that doctors working in public hospitals could not afford to spend too much time
with each patient given the sheers numbers they had to cater to, but private practitioners,
who are not required to treat as many patients as their government counterparts, often
recommended tests as a “defensive app roach“. These tests, he explained, helped them
avoid potential litigation. He warned that too many diagnostic tests, while central to the
treatment being provided, posed a health risk to patients and increased the cost of medical
care as well.
Some doctors themselves concurred in the commonly held belief that doctors order tests,
often unnecessarily , because they get a commission for each of them. In fact, there are
frequent occasions when the findings of diagnostic tests are not corroborated by what the
medical examiner finds during a physical check-up. Dr Kameshwar Prasad, professor of
neurology at AIIMS, recalled an interesting case. “ A decade ago, a former member of
Parliament from Bihar came to me with cervical spondylitis. Based on MRI tests, he was
advised surgery to avoid complication by all the doctors he had approached. But physical
examination did not reveal such a severity to me, so I told him to delay surgery . He is
doing fine without surgery to this day ,“ he revealed.
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4. Contd…
Interestingly , senior doctors are aware that clinical examination is on
the wane. Some have even sought ways to reverse this.Dr S K Sarin,
former chairman of the Medical Council of India, said that in 2010 he
had proposed exit exams for medical graduates. “The purpose of the
initiative was to address the declining clinical skills of doctors,“ he
explained. “Medical education must assess their ability to clinically
examine the patient to avoid unnecessary tests.“
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