The importance of clinical skills

BMJ 1995; 310 doi: http://dx.doi.org/10.1136/bmj.310.6990.1281 (Published 20 May 1995) Cite this as: BMJ 1995;310:1281
  1. J Goodwin
  1. Emeritus professor of clinical cardiology Royal Postgraduate Medical School, London W12 0NN

    High technology investigations do not diminish the need for clinical skills

    The advance of medicine depends on the union of clinical art with high technology science. Sophisticated investigative methods improve clinical awareness and ability, but doctors and nurses must know how to interpret the results produced by the instruments they use. They must be aware of the limitations and possibilities of error. Uncritical reliance on values obtained by machines can be dangerous.1

    Over 100 hundred years ago Anstie commented on the value of the sphygmograph but warned that it should be “used in conjunction with the strictest and most diligent observance of other means of clinical research.”2 Thirty years ago Godber wrote, “Though mechanical aids and measuring devices extend the capacity of the doctors to serve the patient, they do not replace him. They are the adjuncts to the human relationship between doctor and nurse and patient; they cannot replace the art.”3

    A good example of the clinically inexperienced being dependent on high technology is provided by the Swan-Ganz catheter for measuring intracardiac pressures in critically ill patients. Certainly echocardiography gives more information about the mitral valve and ventricular function than …

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