Old Habits Die Hard in Medicine

My hospital’s mammogram reports have a space for “Date of last breast exam”. That is a relic from the past. How many women, and how many doctors, know that clinical breast exams are no longer recommended?

And how many men, and their doctors, know that DREs, digital rectal exams, are not recommended as a screening test for prostate cancer – or colorectal cancer, for that matter?

And testicular exams have no proven value as a screening for testicular cancer.

And never mind the annual “routine blood tests”, or even the “routine physical”.

I have seen three cases of testicular cancer in my 44 years since medical school. All three found the lump by chance on their own. The message we should give our patients is “Know Your Body”, but don’t be obsessive.

I know, this is hard. I mean, it makes such intuitive sense: Early detection ought to pay off. But once you know the sensitivity and specificity of a certain screening strategy, you often realize that even a positive screening result is much, much more likely a false alarm than a chance for early cure. And what is the expense and worry worth in all those false alarm cases?

It has been said that it takes 17 years for new scientific evidence to become standard medical practice. I believe it sometimes takes a generation to eliminate debunked practice routines.

But, do I myself follow the evidence? Mostly. But I can’t stop listening for carotid artery bruits – because I still believe I saved a few patients from a devastating stroke by doing that.

A Quick Listen

3 Responses to “Old Habits Die Hard in Medicine”

  1. 1 Nancy February 20, 2023 at 9:25 am

    This is a good one. It’s hard to give up less sensitive and specific tests that you feel you perform well and have made good judgements based on even in my physical therapy world, despite the evidence supporting those changing. Nice to hear you say the same and your point is good.

  2. 2 Barbara February 20, 2023 at 7:28 pm

    Medicine is no longer the Art of Healing.

  3. 3 David Felker February 21, 2023 at 5:40 pm

    You’re a kindred spirit Dr D!

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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