There was a time when the doctor's black bag, filled with its assortment of diagnostic tools, was indispensable. It was a time when medicine was "high touch, low tech." Today, the reverse is true. Too many of us have abandoned the thorough bedside examination in favor of sending the patient off for an MRI or CT scan!
This is unfortunate, says Dr. Abraham Verghese of Stanford University's School of Medicine. In his keynote address at the recent Texas Medical Association meeting in San Antonio, Dr. Verghese told his colleagues to "pick the low-hanging fruit," to first do a thorough diagnostic exam at the bedside. Then decide what further studies are needed.
Although making an astute diagnosis is important, says Dr. Verghese, there's another reason for a thorough bedside exam -- "the power of the doctor's touch" -- what he refers to as a ritual and the "pinnacle" of the physician-patient relationship.
To make his point, Dr. Verghese has gone back to carrying a black bag on hospital rounds. In addition to its usual tools, he's added two more -- an iPad and a hand-held ultrasound. The iPad has proven to be a valuable teaching tool, not only for his medical students, but for patients as well. And, although the hand-held ultrasound does not take the place of additional imaging studies, it has added another dimension to the physician's capacity to make an accurate diagnosis at the bedside.
(To sharpen your bedside skills, I highly recommend The Stanford 25Website, "an initiative to revive the culture of bedside medicine,")
Ken Teufel is the Medical Director for Interim Physicians