Indian Journal of Occupational and Environmental Medicine   Official publication of Indian Association of  0ccupational  Health  
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  Table of Contents 
EDITORIAL
Year : 2015  |  Volume : 19  |  Issue : 3  |  Page : 123-124
 

Changing scenario in the art of clinical medicine


Occupational Health Consultant, Chesnut Plaza, Shop No. 16, Second Floor, Opp. Endenwoods, B. Nath Pai Marg, Thane (W), Maharashtra, India

Date of Web Publication14-Jan-2016

Correspondence Address:
Ganesh K Kulkarni
Occupational Health Consultant, Chesnut Plaza, Shop No. 16, Second Floor, Opp. Endenwoods, B. Nathpai Marg, Thane - 400 610, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5278.173996

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How to cite this article:
Kulkarni GK. Changing scenario in the art of clinical medicine. Indian J Occup Environ Med 2015;19:123-4

How to cite this URL:
Kulkarni GK. Changing scenario in the art of clinical medicine. Indian J Occup Environ Med [serial online] 2015 [cited 2019 Apr 24];19:123-4. Available from: http://www.ijoem.com/text.asp?2015/19/3/123/173996


The practice of clinical medicine judiciously combines the art of clinical medicine and medical technology. Medical technology is continuously evolving to support early diagnosis, but the dependence is growing at the cost of the art of clinical medicine. The advances in biophysical techniques and biometrics have given the edge to clinicians but the art of clinical medicine is a fundamental skill that needs to be nurtured at all times. The combination, of medical knowledge, analysis of data form technology, intuition, and the judgment to decide on treating or not treating a patient, is the art of clinical medicine.

Today, the tendency for the physician is to consider the patient as a case of a particular disease and in hospital as a bed number. There is a need to relate to the patients or employees that we are caring. The focus needs to be on his emotional, social, occupational, and financial requirements, as well as in understanding his family background. Hence, there is an urgent need to rethink on the “patient–physician relationship.” The present-day medical practice has changed because of an altered setup in which a physician practices. The patients are realizing their legal rights when seeking medical help and the physician is aware of his legal obligations toward his clients. The statement of Dr. Francis Weld Peabody many decades ago aptly summarizes, even today, the patient–physician relationship, “The significance of the intimate personal relationship between physician and patient cannot be too strongly emphasized, for an extraordinary large number of cases both diagnosis and treatment are directly dependent on it. One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.”

The aspect of detailed history taking is very crucial in determining the course of clinical attention and history taking on one's occupation is very important in establishing the “cause–effect relationship” in the diagnosis of an occupational disease or disorder. One must encourage patients speaking about their symptoms rather than discussing about undiagnosed diseases. Information on family history is equally needed to detect genetically transmitted diseases or genetic and family disposition to a particular disease. The personal history shall assist in understanding the patient's addictions, nutrition, and physical activity.

Physical signs are objective and verifiable indications in clinical diagnosis. The clinical signs should be indisputable and verifiable by all clinicians. The physical examination should be made thoroughly and systematically from “head to toe” and should not be restricted to the system indicated by the patient's history. Unless the examination is carried out in a systemic manner, important physical signs may go undetected. This is a pitfall in which many efficient physicians have fallen because of their busy schedule. Skill, in clinical diagnosis, improves with experience, provided a physician follows his patients and realizes his faults, errors in judgment, and his achievements in physical diagnosis. One should always remain open-minded and accept an error in clinical diagnosis or the recognition of a physical sign. Experience as well determines that a physician look for a particular physical sign while considering the differential diagnosis in a patient. The saying “You see only what you look for” is more true in finding the abnormal physical signs. Repeated physical examinations are needed, as physical signs keep changing with respect to time and treatment.

Physicians should not depend entirely on laboratory investigations and imaging techniques for diagnosis. Any isolated abnormal laboratory findings and tests with low specificity and sensitivity need in-depth workout before arriving at diagnosis.

The clinical diagnosis of a patient requires a logical approach in analyzing and interpreting clinical data with available investigations. This approach is more important especially when the diagnosis is difficult to make. Today, physicians must focus on care with compassion, rational drug usage, avoiding iatrogenic disorders, and cost-effective medical care.

Because the understanding and practice of occupational health depends on the sound foundation of clinical knowledge, it is important to upscale one's clinical knowledge all the time. There is a need to transfer this tacit knowledge to the next generation by dedicating time for teaching undergraduates and postgraduates in medical institutions.

No greater opportunity, responsibility, or obligation can fall to the lot of human beings than to become a physician. In the care of suffering, he needs technical skill, scientific knowledge, and human understanding. He who uses these with courage, humility, and wisdom will provide a unique service for his fellow men/women and will build an enduring edifice of character within himself. The physician should ask of his destiny no more than this, he should be content with no less. These wise words are all applicable and relevant in the present changing scenario of the art of medicine.




 

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