As a fans of Sherlock Holmes, I must say I am more fond to the British medical system than the American one: diagnosis has to be arrived clinically, when the investigations are just confirming your suspicion. In short, we have to have something in mind before requesting one investigations, be it a complete blood count or a PET-CT. As the professor of paediatrics Patrick Yuen says, a good history taking and physical examination is the hallmark of a good physician. Interns of surgery are no exceptions.
However, what disappoints me the most is that, medicine in HK is gradually turning into a american one: we basically do many investigations, but not a lot of ideas in our mind of what is happening to the patients. You may say, well, investigations are cheap, but even a blood taking will cause pain to the patients, and this feeling is not cheap. Let alone a OGD or a colonoscopy. Well, there is no need for a doctor like me to book those investigations, as anyone who has knows how to use computer can click those items in the system, booking all those investigations, be it necessary or unnecessary for the patients. The so-called 80% diagnosis can be arrived based on clinical skills is perhaps myth.
But one day I know it really can happen. When I start to pay attention to what patients tell me, I can make a better clinical judgement without subjecting the patients to unnecessary tests. On the other hand, I don't need those high-tech tests to make a good diagnosis for the patients. The stories told by our seniors are true. We can do it. We can beat the machines with the most simple means: conversations and then physical examinations.
I could not but thinking of the old sayings from Sir William Osler. Listen, the patient is telling you the diagnosis.
