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Randall Burchell's avatar

Newer doctors are being trained away from physical exams, I believe due to time constraints rather than from utility. They quote “ use of evidence based studies” , which we now know are frequently rubbish , influenced by higher powers for their own purposes.

Any doctor who has helped a long time patient avoid serious issues from a finding on exam knows this personally. Many younger doctors have less reference frame and are employees slotted into a practice, without the need to build relationships with patients over time.

They have their faces buried in a computer and are pressed for time to improve their metrics and “ quality

scores. After being in practice for 32 years , I’ve seen both sides, private and group practice. Time is what patients deserve and doctors need to be given. The current system does a disservice to both.

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J Askins's avatar

Adam, I think this is your best article I have read. Putting Dr. Fred’s observations and tenets in a present day context illustrates and explains so much of the stress and burn-out among physicians who approach their patients with compassion and critical thinking skills. Too often, we see patients who have had 3 CT scans, serial high-sensitivity troponins and ECGs, and consultation requests to 4 different subspecialists, all in the first couple of hours after arriving at the hospital. As an “old-fashioned doctor” consultant, disappointment occurs upon discovering there is no differential diagnosis or demonstration of thought clarity within the 9 page “history and physical” created by the guideline-directed hospitalist key stroking the template-infested EMR. Unfortunately, the discharge summary is but a 20 page regurgitation of the 8 hour and $30,000 ER visit when it could have been better communicated with a 2 paragraph composition summary of what happened. I encourage your readers to link to the excellent article written by Dr. J.T. Wilkerson commemorating the life of Dr. Fred. We should all realize what American medicine has lost with the absence of educators like Dr. Herbert L. Fred. The comments to this article by your readers have been encouraging.

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