Of Evidence based medicine

When Patient became a client & Doctor a consultant

Gone were my MBBS days when…
…I was supposed to reach one Diagnosis & few differential Diagnosis with reasons before I can propose any investigation ( with proper justification of course). It was 80’s. I must examine my patient thoroughly for 30 minutes using all my god given senses: History taking ( all ears) , Inspection ( all eyes), Palpation ( touch) , Percussion( vibration ) before Auscultation and other senses onwards. Those were days when my patients believed me. Some of the smells had been classified then.

First Forward to present day US sponsered evidence based medicine.
.. You must transcribe every evidence of your patient ( now client ) contact, exhaust all kind of investigation technique before touching the patient. Dialogues must be recorded. History taking is getting replaced by study of past electronic medical records followed by sheets of investigation reports. Palpation & Percussion are deleted with partial modification of Inspection & miniscule auscultation for a personal touch purpose only.
I believe the ubiquitus stethoscope which has been reduced to a staus symbol of the doctor uncle will be soon deleted from doctors’ apparel.
..The client has little faith in you. He has come with 360 degree pre-information about his suffering & your antecedent from Net. You are aware that each bit of your interaction is going to be researched from 360 degree angle by his support team in India & abroad . Unfortunately your vision is limited to 180 degree in front only.

II.

My professors used to give consultation in an out-house of their residence, examine the patient for half an hour & give out stamp size prescriptions. One line diagnosis & two line medicines. Most of the patient records were in their memory. (sic)
My kids keep their clients busy in five star ambience ( gorgeous reception, channeled TV , coffee & glossy magazines in lounge ) while shifting through their past e-Medical Record, Insurance package, seafs of investigation, Interact few minutes & hand over voluminous plastic jacketed folders with one page full medicines & few more pages of favorite healthcare apps with id & password. Your progress is auto tracked & auto updated.

No doubt my kid is a smarter consultant, better record keeper & health insurance agent than my professors. In those days also lawyers & LIC agents used to average better than practitioners.