By Mark A. Kelley, MD |5/24/18
Founder, HealthWeb Navigator
I teach first-year medical students how to take a medical history and perform physical exams on patients.
These skills are the foundation of medicine. The health history and physical exam (plus a few basic tests) are time-tested methods for diagnosing disease. Using these tools, a skilled physician can reach an accurate diagnosis more often than not.
We humans share a standard range of symptoms. Pain, weight loss, fever, cough, abdominal complaints—are all examples of the body’s response to injury, infection, and inflammation. The range of diseases, while large, is still dominated by common conditions such as cancer, infections, heart and lung disease, etc. And how the human body reacts to these diseases has remained constant. A cough is still a cough—whether now or 4000 years ago.
As a former pulmonary and critical care physician, I treated patients with diseases ranging from common to exotic. No matter the scenario, the diagnosis becomes apparent if you are a good listener. As I tell students, if you ask patients the right questions, their answers will help solve the problem.
I teach first-year students because they have a refreshing perspective on medicine. They are eager to meet patients, who in turn seem to enjoy the experience.
Unfortunately, my students will likely spend more time with these patients now than when they are practicing physicians.
During their hospital rotations, students will quickly learn that time has become medicine’s coin of the realm. Filling out forms and clicking through computer billing systems devour time, leaving very little for a meaningful discussion with a patient, much less for developing a relationship.
Many dedicated physicians work within this time trap, and their patience is wearing thin. The warning signs are clear. More than 50% of physicians are experiencing burnout. Many respond by leaving clinical practice or retiring.
Is clinical practice becoming a sweatshop, where physicians are treated like assembly line workers and the only important metric is the bottom line?
Maybe—but only if we ignore human nature. When illness strikes, we all seek comfort from others. For millennia, our ancestors have received such help from trusted healers. I doubt that is going to change. One of life’s certainties is that we all become a patient eventually.
Medicine is having a Dickensian moment: we are now witnessing both the best and worst of times. We have a dysfunctional healthcare system complicated by high costs, mediocre quality, and chaotic public policy. Yet we are also on the verge of major scientific breakthroughs in basic science, information technology, and data analytics.
My bright first-year medical students understand this paradox and view it as an opportunity to improve healthcare. As I reflect on my own student days, I can remember feeling the same way. Throughout history, medicine has lived at the intersections of science, technology, social reform, and economics. Most problems have solutions, if we are bold enough to execute them.
Each new generation is equipped with the courage, creativity, and energy to create lasting change. As my students begin their careers, the most important lesson I can teach them is to make patient care their top priority. That happens only when the doctor-patient relationship is held sacred.
If students set their sights on this one goal, they, like countless students before them, can improve the lives of patients in ways we cannot imagine.
Hopefully I have gotten them off to a good start. After all, one of them may take care of me some day.