High-tech gains spell loss for hands-on practice

December 4, 2009

Bent down with stethoscope against the patient's chest, he listened for what seemed like a week, or maybe two.

Bent down with stethoscope against the patient's chest, he listened for what seemed like a week, or maybe two. His eyebrows gave the only sign of something happening, randomly twitching up, now down, while every other muscle in his body appeared petrified. Finally, he stood up, pulled the 'scope from his ears, and pronounced his verdict.

“Aortic stenosis, with a gradient of 52 mm Hg.”

Our small herd of white-coated residents and students murmured admiringly, knowing we were in the presence of a true master. Most of us also knew we were witnessing the end of an era.

This cardiology attending was so skilled in evaluating heart murmurs, and so accurate in estimating their severity, that we almost didn't need an echocardiogram. He'd been trained before there were echoes, when the only diagnostic tools were an ECG, a stethoscope and a thoughtful pair of ears.

There were others like him-surgeons who could touch a hand to a patient's belly and know at once whether surgery was needed, neurologists who could read the complex story of a patient's presentation like a child's primer, internists who could tell precisely how much fluid had accumulated in a patient's chest by tapping on the thorax and noting subtle changes in the pitch-all of the same generation.

We, however, were deep in the grasp of high-technology: echocardiograms, nuclear medicine, CT scans, ultrasound, MRI, and more.

We could never hope to duplicate the expertise of these older physicians, and that brought a certain sadness as their skills became devalued.

At the same time, we found them quaint and perhaps a bit old-fashioned: charming, impressive, and fascinating but still bound for extinction. Why spend 30 minutes listening to someone's heart when you can get an echo and have all the answers, objective and preserved forever? Why bother learning to percuss a chest, or palpate an abdomen, when you can get an ultrasound, or a CT scan, ultra-fast and all-knowing.

No one would dispute that high-tech imaging brings many benefits. But there's a downside in addition to its high cost: we are losing our ability, and our desire, to diagnose disease without it.

Only a few fringe types know how to spin wool these days, and fewer actually do it. The rest of us just order a new sweater online, happy to be free of what we view as drudgery. So it has been in medicine for the past 30 years, and there's no indication it will stop anytime soon.

I celebrate the advances medicine has made in recent decades, but I also mourn the loss of connection. That beautiful sweater tells me nothing about the wool, the sheep, the land that formed it. And that CT scan's many shades of grey say nothing about the person living in the images, the pain, emotion, or meaning behind the pixels.