We need more “old fashioned” doctors


Category : Medical Rants

Recently at dinner a pediatric nurse practitioner made a comment that we need more “old fashioned” physicians. What did she mean? She went on to opine that most physicians now do not spend enough time with patients. They shortchange the history and physical and rely mostly on tests.

Recently I have seen the GE ad about technology too many times. This ad plays on technology being the answer to medical care. This ad unfortunately influences our population to expect technology answers to every medical problem.

I do not consider myself a Luddite. But I believe technology is a tool not an answer.

Once upon a time we had Marcus Welby. We valued the kind physician, the concerned physician, the patient physician.

We really do need physicians who take the time to understand their patients. During the ACP meeting, Abraham Verghese spoke to the ACP Governors and Regents. He talked about his writing and about understanding our patients. As always he stressed spending the time to know our patients and understand them.

When we try to rush the process, the patient suffers. When we take short cuts with technology, we rarely help the patient.

Spending time with patients should not be considered “old fashioned”. Using technology sparingly should not be considered “old fashioned”.

I do not know how we get back to the ideal of the physician patient relationship, but I know that we should.

Comments (9)

Two worst beliefs in medicine:
Old is good, new is better.
As you say, what we need are old-fashioned physicians who know how to use the new technology.
Presumably that’s what they should be teaching in medical school.
Can’t say because I don’t teach anymore but it doesn’t sound like it to the residents and young attendings I work with.

Critical thinking and meta cognition during data gathering. Is not old fashioned.
That is wisdom that you said trump knowledge…using technology without bedside data for clinical correlation is lamed duck,not expert..

I was reminded of the story of a local doctor who had passed away after years of service to the local children’s hospital. His later career was filled with mentoring, staff problems, and consulting. His son had taken his position as chief of pediatrics.

A little girl is brought in who is very sick, but she is not getting worse, but she is also not getting better. Test were run and run again with no results. This doctor was called in and being the grandfatherly type got along well all of the children. He goes in and talks with the little girl, plays what appears to be some silly games, but all have the purpose of measuring her responses.

Leaving the room he spoke one word, polio. This was impossible because checking they found she had been vaccinated. Then the real work began, interviewing family and friends. The result was finding out a distant family member had been in Africa and came in contact with a slightly different strain of polio. The little girl’s vaccination had protected her from getting the full blown disease, but lack of proper treatment due to no diagnosis had prevented her from improving.

None of the doctors working at the time had ever seen a real case of polio. This doctor was practicing medicine at its best, using his skill and knowledge to improve the life of this little girl.

The little girl then made a full recovery.

Steve Lucas

Its obvious to the wise that above is the right way to practice; the problem is that no one with power to make this happen is listening….unfortunately. A minority of us will keep shouting and dreaming forever. Its become a topic where everyone is happy to talk about it over and over but noone in authority wants to do anything about it..even among smart people, common sense is not common.

Conan Doyle short story Looking for a doctor (about an old doctor) Aorund the Lamp
When Dr. Patterson and I–both of us young,
energetic, and up-to-date–settled in the district,
we were most cordially received by the old doctor,
who would have been only too happy to be relieved of
some of his patients. The patients themselves,
however, followed their own inclinations–which is a
reprehensible way that patients have–so that we
remained neglected, with our modern instruments and
our latest alkaloids, while he was serving out senna
and calomel to all the countryside. We both of us
loved the old fellow, but at the same time, in the
privacy of our own intimate conversations, we could
not help commenting upon this deplorable lack of
judgment. “It’s all very well for the poorer
people,” said Patterson. “But after all the educated
classes have a right to expect that their medical man
will know the difference between a mitral murmur and
a bronchitic rale. It’s the judicial frame of mind,
not the sympathetic, which is the essential one.”

I thoroughly agreed with Patterson in what he
said. It happened, however, that very shortly
afterwards the epidemic of influenza broke out, and
we were all worked to death. One morning I met
Patterson on my round, and found him looking rather
pale and fagged out. He made the same remark about
me. I was, in fact, feeling far from well, and I lay
upon the sofa all the afternoon with a splitting
headache and pains in every joint. As evening closed
in, I could no longer disguise the fact that the
scourge was upon me, and I felt that I should have
medical advice without delay. It was of Patterson,
naturally, that I thought, but somehow the idea of
him had suddenly become repugnant to me. I thought
of his cold, critical attitude, of his endless
questions, of his tests and his tappings. I wanted
something more soothing–something more genial.

“Mrs. Hudson,” said I to my housekeeper, would
you kindly run along to old Dr. Winter and tell
him that I should be obliged to him if he would step

She was back with an answer presently. “Dr.
Winter will come round in an hour or so, sir; but he
has just been called in to attend Dr. Patterson.”

even on conan doyle’s times they needed good old fashion doctors. We needed it too in 2013.

“I do not know how we get back to the ideal of the physician patient relationship”

You’re selling yourself short. EVERYBODY knows how we get back to that ideal, but nobody’s willing to do anything about it.

I couldn’t agree more. But I’m not reimbursed for my time spent….and patients expect a test to be ordered or else you didn’t “do” anything. Not saying it’s right….

Thanks greatly for an honest reply. As you know, you have identified the problem. The solution is much more elusive.

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