A timely observation -Treat the Patient, Not the CT Scan.

A timely observation -Treat the Patient, Not the CT Scan.

Source: NYT Sunday Opinion, 2/27/2011, Abraham Verghese

Stanford University School of Medicine’s Professor and author, Abraham Verghese has made timely observations as our society becomes ever more dependent upon technology and artificial intelligence, particularly as it relates to modern medicine.

“When I was an intern some 30 years ago, about three million CT scans were performed annually in the United States; now the number is more like 80 million.  Imaging tests are now responsible for half of the overall radiation Americans are exposed to, compared with 15% in 1980.” 

Aside from the risk of cancer from radiation, Professor Verghese laments, that the realtive ease of ordering a scan has caused doctors’ most basic skills in examining the body of their patients to atrophy (waste away).  While clinical examination and diagnosis are still core for curriculums in US medical schools, Professor Verghese notes that when the student becomes a physician and enters actual practice, the emphasis is upon, “getting tests ordered and getting results, having procedures like colonoscopies done expeditiously, calling in specialists, arranging discharge. And the engine for all of that, indeed the place where the dialogue between doctors and nurses takes place, is the computer.”

-Medical Technology can blind doctors to the needs of the sick-

As an example of missing the point offered by the Professor is the recent case of a patient, “who arrived in an E.R. in extremis with seizures and breathing difficulties. After being stabilized and put on a breathing machine, she was taken for a CT scan of the chest, to rule out blood clots to the lung; but when the radiologist looked at the results, she turned out to have tumors in both breasts, along with the secondary spread of cancer all over the body.”

As Professor Verghese acknowledges, “In retrospect, though, her cancer should have been discovered long before the radiologist found it; before the emergency, the patient had been seen several times and at different places, for symptoms that were probably related to the cancer. I got to see the CT scan: the tumor masses in each breast were likely visible to the naked eye — and certainly to the hand. Yet they had never been noted.”  This is an error that is being repeated and recorded, “A subtle error that stems from not making use of basic bedside skills, not asking the patient to fully disrobe.”

Professor Verghese concludes that the ritual of examination of a patient, as old as Hippocrates in ancient Greece, is more than simply a ritual.  “I find that patients from almost any culture have deep expectations of a ritual when a doctor sees them, and they are quick to perceive when he or she gives those procedures short shrift by, say, placing the stethoscope on top of the gown instead of the skin, doing a cursory prod of the belly and wrapping up in 30 seconds.”

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