In a recent article available on the NY Times Health Web site, the discussion of the decline in medical practice was taken head on. In this article, the author explored the issue of doctors spending more time in front of a computer, and less time alongside a patient. She discusses the growing dissention among some doctors in following this model, and their desire to bring back the old school, “sit by the bed and look at the patient” method of doctoring.
The real dilemma, in my opinion, is not that docs don’t sit by the bedside, or that they spend time on a computer. I find little fault/value in either. The real problem, is that the doctor’s of today, have had a good deal of their freedom stripped from them, and that in turn makes it less likely that the doc will be able to provide a solution for health, but more likely that they will provide an insurance supported treatment for disease. They have been pushed into a systematic approach, that might provide greater decision making in the diagnostic arena, but lack of freedom on the treatment side.
The author (Pauline W. Chen, MD) provides an argument on both sides of the story, and presents the opinions of a Dr. Karlawish favoring the direction that we are headed, while not giving a primary spokesperson to the dissenting side. This alone is a sign that she favors the direction we are headed, and doesn’t truly have interest in entertaining the idea of trying to find more time for a doctor to sit an LOOK at and TOUCH a patient. To some extent, I would believe this author has no idea of the healing potential in touch. As a chiropractor, I have seen it first hand, repeatedly in my life.
When you read the article, you can see how it would be easy to trust the opinions of Dr. Karlawish (professor at the University of Pennsylvania Medical School of Philadelphia), as he portrays this new method of medicine as being the best solution for our culture. He talks about how treatment options for a patient can be crunched, and then the patient is only treated if the outcome looks good. The problem, is that in our system of medicine, their is no time to get to those details. The reason why we are faced with a new medical system, comes down to the fact that medical costs are a major problem, and the best way for a doc to keep up and make some good money, is to follow the most likely paths of treatment.
Furthermore, the author has this comment:
 One example of a disease in the new desktop medicine era is dyslipemia, or abnormal blood cholesterol and blood fat levels. Cholesterol-lowering drugs were initially used to treat patients who suffered from inherited diseases that prevented them from processing cholesterol, putting them at risk of hardening of the arteries and heart attacks. Over time, though, clinical trials revealed that the same drugs could reduce heart attack risk in some otherwise healthy individuals who simply had high cholesterol.
The issue here, is that by taking the admin of medicine out of clinical judgement, and into formula writing, the medical community at large has faile to see that 24 years of treating with statin medications, has resulted in NO less heart disease, and actually more of it. IF, the drug was an effective way at reducing heart disease, it would have had an impact by now. But docs are blind to this, because they are following the formula, and what they see as a lab result, and then a series of assumptions about morbidity and risk leaves them to believe that treating cholesterol is actually working. Sadly they are mistaken.
So my big culminating point in all of this, is that docs are better served to sit with their patients, get to know their lifestyle, and start to crack away at those small daily changes that would result in better health. The only problem is, they haven’t done this as a whole in thirty plus years… so it isn’t going to happen anytime soon.  Best make your own decisions to be healthy!
God Bless, Dr. E