It was a peaceful Saturday at the clinic, but my pleasant chain of thought was broken by a loud hello. A man in his late 30s introduced himself as a successful senior executive at the local office of a leading multinational information technology giant. His exposure to information science, he said, has made him aware of the need to invest time in his health. I commended his mature insight into life’s priorities, and asked him the reason for his visit.
“I think I need a biopsy,” he said. “Whatever for,” I asked taken aback.
“How else do you propose to diagnose my lymphoma?” The unexpected question knocked the wind out of my sails.
“Whoever told you that you have lymphoma?”
“The signs are all there.” He had entered his “symptoms” into an online app, which unequivocally made the “diagnosis”.
“Would you mind telling me what exactly are the symptoms and signs,” I asked with the greatest respect to the oracle of the modern world, the Internet.
Just aches and pains
“If you must know,” he said rolling his eyes, “it all started six weeks ago with generalised aches and pains; I have been waking up each morning as if I have been through the mill.”
“And then,” he said softly with the air of a writer narrating his story to a prospective film producer, “I noticed a progressively increasing painless lump in the right groin. To think that this happened after working out at the gym under a trainer for the past two months to stay healthy!”
“Since you want me to biopsy the lump for you, would you mind if I examined it,” I asked. “Be my guest,” he said.
I spent the next five minutes examining him. I found a small scar on his right lower belly from an appendicectomy. I couldn’t help but smile as I reassuringly declared that he was safe. The lump was an early groin hernia. “Easily sorted with a standard operation,” I said.
“What about my early morning fatigue, aches and pains,” he countered.
“That is your gym trainer giving you value for your money and your muscles protesting ... Your right groin already possibly weakened by the scar of your appendicectomy might have given up in protest,” I added triumphantly. Sherlock Holmes, I thought, could not have done better.
The furrows that appeared on his forehead and the knitted brow could make Rodin’s Thinker look like he was simply bored. “How can you be so sure,” he asked indignantly, upset by my dismissal of the oracle’s prophesy. My clinical diagnosis, I assured him, was the summation of elements I had picked up from his medical history and signs I had noted on examination, a skill afforded to me by years of training.
“With due respect to you doctor,” he said, “I would be happier if this could be proved through an objective test such as a scan rather than embark on surgery based on human perception alone.”
At this point, I decided it was time to call it quits and wrote him out a request for an MRI. Two days later, he returend a much happier man waving his report. “Doc, you were right! It is indeed a hernia,” he said expecting me to feel happy. I was glad, I said. The perception of the machine projected as images had convinced him that my real-world perception of his clinical situation was worthy of acceptance.
The evident lack of trust in clinical medicine is driving many clinicians to rely more on investigations and imaging than on their professional judgment, sounding the death knell for clinical medicine and driving care beyond the reach of most.