"But Whatever Happened to Physical Diagnosis?"

OLD DOCTOR AS PATIENT

With apologies to Sir Archibald Doggerel, OSJ,OBE

In the ER against my will
the doctor there stood tall and still
around his neck a stethoscope
which quickly gave me added hope
But it was just a decoration
like a TV show sensation
What's your name? Where do you hurt?
listened to my lungs right through my shirt
through the shirt, through the blouse
is he the only doctor in the house!?
Checked my liver with his knuckle
didn't know it's my belt buckle
Off to X-ray for a scan
then ABGs, is that a plan?
Why not have me just undress
check my heart, lungs, and the rest
ask me if my toes are numb?
I may be old, but I'm not dumb
I'm a patient, show some caring
save me from my silent swearing
maybe it's my own neurosis
but whatever happened to physical diagnosis?

George Finlayson,MD

Dr. Finlayson (alpha omega alpha, Western Reserve University, 1953) is retired from practice in Internal Medicine.

Thanks to Alpha Omega Alpha's The Pharos, the first publisher, for permission to reprint the poem from the Summer 2006 issue in this blog.

This poem clearly reflects several wrong medical professional behaviors which unfortunately can happen, and perhaps not uncommonly. First is the usual "rush" in emergency room attention and care which if not controlled can lead to taking inadequate amount of time for a necessary history and performing an appropriate physical exam. But then, this doesn't have to occur in an emergency room but also in a busy doctor's office. Then the rush to the next patient continues with requesting testing with an order but without a thought out and supportive physical diagnosis. (In other words, the testing is believed to make up for the inadequate history and physical.)

Finally, there is the VIP treatment sometimes given to physician patients where the attending physician may, for one reason or another, not wish to disturb the patient with taking a detailed history or subject the doctor patient with what the attending doctor might consider an embarrassing or uncomfortable or overly detailed physical examination.

The old doctors had less tests and more time and more attention to the patient. Whether they could do a better job in diagnosis and treatment of the disease than more modern medicine is doubtful. But one thing is clear, they had the time to do a better history and physical and their treatment of the whole patient might be looked upon as superior. What do you think? ..Maurice.