off record
Shaukat Ali Jawaid

Master Clinical Skills and
practice ethical medicine

The new generation of healthcare professionals have become slave of modern gadgetry with the result that they have forgotten the importance of clinical skills, good history and comprehensive physical examinations of the patient to reach correct diagnosis. Instead, the patient has hardly narrated his story of complaints that they start writing the prescription which includes a battery of sophisticated investigations and final prescription also includes many un-necessary drugs and medicines. In the good old days the physicians used to make most often correct diagnosis based on history and clinical examination and they would order only essential investigations and that too to confirm the diagnosis.

Over the years, things have changed a lot. Under the influence of laboratories, diagnostic centers and pharmaceutical industry, a vast majority of the prescribers forget the fact that high cost of investigations, drugs was one of the important cause for failure of patient compliance with the prescribed therapy. What is the use of those investigations and drugs which the patient cannot afford? The patient’s used to die in the part and they die even today the only difference is that the death has been made much more expensive and they die too much investigated and documented.

It is the responsibility of the opinion leaders and medical teachers to lay emphasis on clinical skills, rational investigations and rational prescribing. But unfortunately the physicians who follow the age old practice of spending some time with the patient listening to their complaints and undertaking good history and physical examination are considered old fashioned doctors. Herbert Fred Professor of Internal Medicine at University of Texas Health Science Center at Houston wrote an excellent editorial1 in Hospital Practice on December 15th 1998 which someone has just shared on the social media. It is entitled “Old-Fashioned Doctors” which is highly informative and relevant still today.

Dr. Herbert in this Editorial has pointed out that old fashioned doctors take medical history, undertake physical examination, they also seek patient’s previous medical history instead of just looking at the discharge slip. They prefer cheap investigations to substantiate instead of generating their clinical impressions. They also use their brains and hearts rather than depending on an army of consultants to manage their patients. They refrain from blindly administering drugs and they know that at times that patients often get well by just consulting a doctor who listens to them patiently and their good rapport with the patients also saves them from lawsuits. Most important if they do not know something, they are not afraid of saying it. He had concluded that even if more and more doctors practice today what old fashioned doctors used to do, the medical profession will regain its nobility and respect which it once used to enjoy.

Let the healthcare professionals follow this advice which will also go a long way in proper treatment and patient safety.


  1. Fred HL. Old-Fashioned Doctors. (Editorial) Hospital Practice December 15th1998. Page-15.
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