What is the point of doctors?
BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f7380 (Published 10 December 2013) Cite this as: BMJ 2013;347:f7380
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I hope the judgement to which Dr Spence refers is the judgement that the doctor makes on the management of a patient to whom he has delivered continuity of care in his capacity as the named doctor. The latter concept is becoming increasingly alien to some of the multipartner practices where the patient who books an appointment only 2-3 days in advance gets seen by a different member of the team each time he experiences a change in his symptoms. The amazing thing is that it has taken a lay person, Jeremy Hunt, no less, to recognise that only the named doctor who delivers continuity of care can pronounce judgement on the state of health of the patient under his care.
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I took me a long time to realise the wisdom of what you have put in your latest contribution.
Now that I am long-retired and relatively impartial [and bolder ] , perhaps I should confess that we were warned about the limits of human understanding, uncertainties of medical practice diagnosis of non-disease by late London physician [and my icon ]Frank Dudley Hart in his 1961-2 series of articles in The Practitioner.
And some 30 years ago, I mentioned this subject with some trepidation to Dr Hart, he modestly corrected me that Osler had made "original observations and expressed them more succinctly ".
You could well be standing on the shoulders of such giants of Medicine. Des !
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This was a good analysis of the current situation in clinical medicine. Clinical experience is needed not because we have limited investigations but because we have too many. Browsing the internet because of mild symptoms people find irrelevant threats which bring them to us, doctors.
The internet is full of information but seriously lacks sense of relevance. My role (as a private practitioner) is too often just to reassure my patients that there are no signs of any dangerous neurological diseases.
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Re: What is the point of doctors?
I am inclined to agree that the role of a doctor is more often to interpret and ignore tests than to blindly follow guidelines.
However, the increase in "mushrooming psychological problems" and "nebulous physical symptoms" hardly suggests an "ever bigger haystack of wellness."
Mental and substance use disorders are already the leading cause of years lived with disability.[1] However we choose to label them, these psychological problems, along with the "rise and rise of medically unexplained symptoms," are a real cause of suffering which cannot be alleviated by any amount of technology - in fact, they may well be caused by too much of it.
The uniquely human aspect of dealing with patients whose psychological and physical symptoms cannot be easily boxed, and who cannot treated on the basis of some randomised controlled trial, is precisely the point of doctors.[2]
The day I feel my patients can be better consoled by a vending machine than human interaction will be the day I leave medicine.
1 - Whiteford et al. (2013). Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet 382:1575-1586
2 - Thomas et al. (2010). The anomalies of evidence-based medicine in psychiatry: time to rethink the basis of mental health practice. Mental Health Review Journal 17:152-162
Competing interests: No competing interests