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Medicine used to be fun. I could spend time chatting to patients and listening to their ideas, concerns, and expectations. Hopefully, despite their predicament I could bring them\u00a0hope that we, the \u201cmedical profession,\u201d could make a real difference. Has the digital age shattered this ethos?<\/p>\n
William Olser taught us that the key to a diagnosis was in taking a patient’s history, and in examining and listening to the patient. Indeed, in medical school and while preparing for the\u00a0Practical Assessment of Clinical Examination Skills (PACES) exam as a junior doctor, the importance of \u201cideas, concerns, and expectations (ICE)\u201d is constantly emphasised. I recently spoke to a\u00a0core medical trainee (CMT) to ask how her training was progressing and whether\u00a0she had any concerns that we would need to work on, as she was preparing for her exams. Her reply was, \u201cI know much of the learning is experiential and self-directed, but unfortunately training time is limited. I spend three minutes with the patient and seven minutes in front of the computer.\u201d This gave her little opportunity to develop the skills necessary for the PACES exam.<\/p>\n
How can one obtain the necessary clinical experience without spending sufficient time with patients? Without this it is difficult to learn\u00a0essential clinical skills or develop\u00a0a \u201cgut feeling\u201d of what might be wrong with a patient. Has the digital age taken over? I enjoy medicine immensely, but I wonder whether technological advances and targets have caused us to drift away from what is essential from both a medical and nursing perspective.<\/p>\n
It is also having an impact on\u00a0morale in the NHS, which is low and in need of re-energising. The most common complaint that I hear is about the amount of paperwork and electronic forms that need completing. I wonder are we heading towards an American system where the average intern makes up to 4000 clicks on his computer per day and the array of investigations trumps the basic, but essential clinical skills of history and examination. It is important that we focus on the most essential skills of a doctor: to be a diagnostician and, at the same time, care for patients in a holistic way. That is not to say that this does not occur, but it is becoming more challenging.<\/p>\n
Most recently, the creation of the \u201celectronic board round\u201d has further exacerbated this situation. It involves aimlessly looking at names and\u00a0reaching\u00a0a possible diagnosis.\u00a0Without even\u00a0seeing\u00a0the patient, one has to try to understand whether the diagnosis is\u00a0correct or what might be missing. The patient is not even involved in this process. By the time we have reached the last\u00a0patient on a long list, it is hard to recall the first lot of patients and give appropriate\u00a0feedback. It would be a far\u00a0more useful approach to go round the ward, see the patients, discuss their diagnosis\u00a0with them, and agree on a management plan with them. Surely the combination of seeing, hearing, and understanding the context is more powerful, but the \u201ctraditional ward round and team approach\u201d seems to be outdated.<\/p>\n