STANFORD, CA –  A New England Journal of Medicine article by a Stanford physician warns medical schools against letting technology take the place of bedside skills.

Abraham Verghese, MD, doesn’t blame technology for this trend. Instead, he turns his attention to medical education and educators like him in saying the “chart-as-surrogate-for-the-patient” approach to medical care is no replacement for the skilled, hands-on physical exam.

He says the advent of computerized medical records and easy availability of diagnostic tests has led to physicians to the “iPatient” – the virtual construct of a patient based on all the lab tests and imaging – even before they meet the real live human version waiting nearby in a hospital bed.

“The iPatient’s blood counts and emanations are tracked and trended like a Dow Jones Index. ... The real patients keep the beds warm and ensure that the folders bearing their names stay alive on the computer,” said Verghese.
He says there is a new push at Stanford to emphasize and improve bedside examinatio skills in students and residents in internal medicine, and calls for a similar national effort at all medical schools.

Charles Prober, MD, senior associate dean for medical education and professor of pediatrics and of microbiology and immunology at Stanford says, the university is taking steps to ensure that technology does not replace medical students’ bedside skills.

In particular, he says, “Beginning with our incoming class of 2008 (current first-year students), we developed and implemented a program, E4C, or Educators-for-CARE (Compassion, Advocacy, Responsibility and Empathy). This program was expressly designed to enhance the bedside skills of our students while underscoring the critical guiding principles of physicians as compassionate, responsible and empathetic advocates for their patients.”

“The program matches groups of six incoming students with a single faculty member who will serve as the students’ guide and mentor in the approach to patients throughout the students’ time in medical school,” he said.
Verghese says doctors spend an “astonishing amount of time in front of the monitor charting in the electronic medical record, moving patients through the system and examining tests results. And medical students learn through example.

“In short, bedside skills have plummeted in inverse proportion to the available technology,” he said.

According to a 2008 survey by the American Board of Medical Specialties, when it comes to choosing a doctor, most Americans rank bedside manner and communications skills at the top of the list of qualities important to them, far ahead of the doctor’s hospital affiliation, place of training or office location.

“Communication skills are increasingly recognized as an essential component of quality healthcare, and not something that’s nice, but not necessary,” said ABMS president and CEO Kevin Weiss, MD.

 “These survey findings confirm that patients are demanding that their doctors treat them not just with medicines and procedures, but with empathy and information that they understand.”

“I truly believe that good bedside skills make residents more efficient,” Verghese said. “Doctors who rely on hands-on skills tend to order tests more judiciously, reducing the number of unnecessary and expensive trips to the radiology department.”