Psychologists tell us that we should reward the behavior we want rather than punish the behavior we do not want in order to get folks to do what we wish. How do the academic physicians who teach us now reward just that approach of doing a history and physical as the actual means of making the diagnosis? How do insurers and third party administrators and attorneys and HHS reward that behavior?

We can talk about how the diagnosis is a hypothesis, and about how history and physical and tests are procedures to disambiguate and falsify the guesses you have (Popper, no?) until what you have left is the Truth – which will set us as well as The Patient free. And this is what we really do, although less and less formally now. Dr Bones McCoy’s Tricorder is our scientific method this century because that’s what has been rewarded. Every one of us who is, or has been, a solo practitioner knows this. Art has become the product of our disposable time, and we have no disposable time left.

So, will the ACP and the AAFP and my own American Academy of Neurology and, especially, surgeons and pathologists – who used to be the “intellectuals” of medicine, they would say – will these folks and others take a stand in the public forum, leave the academy and proselytize about the art of diagnosis? Or will the academy just produce more talks like I just had at MCG: “let’s not forget Bayes’ Theorem, boys and girls… isn’t it good to calculate our own probabilities?” And we all wondered what price CME’s.

Until it’s a more efficient use of physician time to explain why an MRI is unnecessary than just to go ahead and order the damn thing so you can get on to the next “consumer”, and then go from that MRI to every other test the poor radiologist suggests when he sees a disreputable pixel, well… Until consumers once again have faith that doctors really are doing the right thing even if that doesn’t involve doing “that test my cousin had”, won’t we continue to face this conundrum of the false positive in this test of relationships?