Medicine is definitely one of the most rapidly developing fields of all. It’s amazing how far we come every single year. It’s said that by the time a med student finishes med school, most of what he learned has already been updated, modified, or even proven wrong and replaced. Someone who practiced medicine 70 years ago would struggle right now with all the new innovations and technology that have been introduced into the world of medicine. Not all advancements are in the form of technology, as we now also have evidence-based medicine and guidelines which didn’t exist over 10 years ago.
All of these tools and innovations are there to make medicine easier and more precise. Yes, it benefits the doctor and saves time to have a better diagnostic or therapeutic tool, but the real winner here is the patient. Accurate diagnoses can be made that allow us to treat patients adequately and with better precision. Of course, tests are at the top of these diagnostic tools. With every passing month, new tests are being made to make diagnosing patients a less ambiguous matter and a more definite one. Just like with everything else, diagnostic tests can be abused or used in excess. Some doctors are more likely to rely less on history and examination and head straight for a diagnostics test. It’s important to remember that tests are there to aid us and we use them based on information we collect. They’re not the answer to everything, or else we wouldn’t even need physicians anymore.
Taking a thorough patient history is important for a variety of reasons. First of all, it gives patients the opportunity to talk. You’d be surprised at the number of people who visit a doctor just to vent and talk. Skipping this part is taking away something valuable from the patient that might impact their health negatively. Another great value to adequate history taking is establishing a relationship with the patient. When you take down someone’s history, you ask about their personal life and you listen to their story. This is where a patient will learn to trust you. If you’re a good listener who doesn’t judge, then your patients will know they can trust and rely on you, which is the basis and foundation of any proper doctor-patient relationship. This trust and relationship can have a positive impact on the outcome of someone’s condition. On the other hand, if history is skipped, then patients won’t get a chance to talk to you. And if they can’t talk to you, then how do you expect them to trust you? They’re likely to go to another doctor who spends more time with them, or they’ll continue to be your patients, but they’ll be uneasy about it.
So history is taken down not just for your sake, but also for that of the patient. History is an essential process for doctors because it allows them to pinpoint or narrow down their diagnosis. Following proper history taking, a quick examination should be done to narrow down a differential diagnosis, then tests are done to confirm one of the differentials.
A few years ago in less-developed countries, doctors still rely heavily on examination. A cardiologist would rely on their stethoscope to try and assess the heart through heart sounds and murmurs. An internist or gastroenterologist would palpate the abdomen carefully, looking attentively for any abnormalities or organ enlargements. Now, most cardiology clinics have an echo and most internists have an ultrasound. Instead of taking the time to examine patients, most doctors hastily rush to use these machines. Of course, echoes and ultrasounds are amazing, but why not examine first? Maybe you can hear or palpate something that you would then further examine using the machine. And if you miss something by examination, you needn’t worry as you’ll then use the ultrasound and make sure everything is okay.
Taking advantage of available tests can be a waste of resources. Imagine a rheumatologist who orders all the serology tests for every patient who comes in and complains of joint pain. Instead, if he or she took the patient’s history and the patient turned out to have morning stiffness and an affection of certain joints in the hand. then the doctor would be pointed in the direction of rheumatoid arthritis. Instead of ordering a host of serological tests, the required ones would be narrowed to rheumatoid factors and anti-CCP. Ordering excessive imagining studies for patients unnecessarily isn't just a waste of valuable resources, but can also be hazardous to patients as they’re exposed to unnecessary radiation. So keeping insurance and how much a patient has to pay for these tests is something that has to be kept in mind. The safety of patients should also be a top priority.
Patients have this solidified image of doctors so ingrained that any deviation from that image is bad. They want a professional person sitting in a clean, well-organized, neat office who speaks with confidence and seems knowledgeable. They also want someone who listens to them and cares for them. like we mentioned before. A doctor who goes straight to ordering tests will almost certainly lose a patient’s trust. This isn’t just because a doctor-patient relationship wasn’t founded, which is a major part of it, but because this isn’t how they perceive doctors to be. In the head of a patient, they want the doctor to show that he or she has some kind of clue of what’s going on. Why? Because this helps reassure the patient. If a doctor doesn’t know what’s wrong with me, then it must be something terrible or complicated. Is that something you want your patients to feel? Probably not.
By talking to them and examining them, patients will know that you’re onto something or that you’re looking for something. When you then ask them to do a few tests. they’ll know that they’re in line with what’s on your mind. On the contrary, if you just hand out a bunch of test requests, they’ll think the worst - that something is terribly wrong with them - and that since you don’t seem to know what’s going on with them, there will be additional tests to follow, which means additional errands and expenses. How patients perceive you to be doing your job is an essential and deciding factor of whether or not they’re going to come back for another visit or not.
The best thing to do is to combine your skills and knowledge to get the best use of the technology available to you. You spent 4 years in medical school and at least 3 years of residency learning how to be a doctor. There’s no point in throwing all that away and relying heavily on tests. Use your skills and knowledge to narrow down your diagnosis, then confirm it with a test. Someone who is good at their job knows how to do more with less. This applies to anything, not just medicine. Anyone can ask for all the tests in the world and read their results. Actually, this is where tests can be misleading as well. Lots of tests are inconclusive and have false positives or negatives. If you’re just following test results blindly, then you might make wrong decisions that could end up in patients getting hurt and you being sued or potentially fired.
Use your skills and abilities as a physician. You’ll make the patient more comfortable, earn their trust, save resources, and avoid any harmful effects of these tests. You’ll also know how to best interpret the test results you receive. In the end, it’s all for the benefit of the patient.