Deep Knowledge Needed for Expert Diagnosis and Treatment

In a world where a blood pressure of 140/90 is a failing grade and 139/89 is a winner, seasoned physicians sometimes get accused of not moving with the times. But, of course, we still remember the world we grew up, trained and practiced in - Medicine, as opposed to today’s Metamedicine, which is a parallel universe where data is king, regardless of just how valuable it is for individual patients. A one point difference in a numeric parameter could easily be compensated by non-quantifiable things like how good this patient’s diet is and how good their social support system is.

I have written many times about the different views of physicians as either professionals or skilled workers. So many things in medicine today can easily be done by skilled workers with less training than physicians. But, like it or not, I think there are two things that require professionals with their greater depth, gained through more years of training in a more scientific environment. The first one is making a correct diagnosis when unsorted patients present with a jumble of symptoms. The second is explaining their disease or condition and guiding patients through the process of choosing the treatment approach that best suits their own phenotypes, circumstances and preferences. You have to know your diseases well to be able to individualize treatment for a variety of real people with real differences, even though they have the same diagnosis.

Rapid and accurate diagnosis for patients who are sick and scared is not a priority we hear a lot about these days. The low hanging fruit of public health and preventive medicine is, like flu shots, blood pressure control and recommended screening tests. Fancy procedures and expensive pharmaceuticals are getting a lot of attention, but nailing a difficult diagnosis by really knowing your stuff is an almost a forgotten and neglected, certainly undervalued, art form. And I have a hunch why that is. You can’t do prospective, double blind research about it. It’s hard to measure and probably even hard to conceptualize for non-clinicians. It’s sometimes even hard to identify when care is fragmented without a centralized EHR.