A Country Doctor Writes:

I think it was Adam Cifu who made me curious to read more of Dr. Herbert L. Fred’s writings. It was one word that started me on this journey, a brand new word, minted in 2005: “Hyposkillia, Deficiency of Clinical Skills”.

Many forces have created this modern epidemic. The availability and reliance on advanced imaging and more or less affordable laboratory panels have replaced old fashioned history taking and physical exam skills. The corporate demands on physicians’ time have de-prioritized our cognitive skills. It is faster to order a bunch of tests than to take a thorough history and physical exam, and the tests we order instead are fueling the big business of the healthcare industry.

I remember during my Swedish internship I was called down to see the Chief of Radiology. “Duvefelt, you’re ordering too many x-rays”, he said. Our hospital didn’t have a CT scanner yet, so this was not about very expensive tests. His concern was mostly my orders for simple chest x-rays. I also remember learning physical exam skills at Uppsala University, taught by older pulmonologists, who could predict what a chest x-ray would look like after their thorough physical exam with inspection, palpation, percussion and auscultation.

Dr. Fred didn’t really think in 2005 that it would be possible to turn the clock back to when doctors practiced Oslerian bedside medicine. He thought that the skill set, particularly among generalists, had already been lost. And now we are twenty years further down this path.

The only place where that skill set may be called for is perhaps the kind of practice I am in, housecalls and telemedicine for patients who have great difficulty leaving their homes for CT scans, MRIs, echocardiograms and EEGs.

Telemedicine in general may also be an area where a physician’s history taking skill is getting better recognition. I wrote about this on KevinMD five years ago in the early months of the COVID pandemic.