Proper Doctoring by David Mendel

Author:David Mendel
Language: eng
Format: epub
Publisher: New York Review Books
Published: 2013-08-12T04:00:00+00:00

Patterns of Practice

The amount of investigation required by an individual doctor depends on many factors. The less experienced need more confirmation. The more skilled the clinical examination and the better the judgement, the fewer the tests that are ordered. In some specialities the physical signs frequently allow a diagnosis to be made without recourse to tests, whereas others are much more dependent on tests. Our ability to test the function of the various systems is uneven. In the respiratory system, for example, almost every aspect of each component can be tested with precision and often non-invasively. In the central nervous system, the quantification of function is much less well developed.

The number of tests ordered by two doctors doing the same work will differ as a result of the interest they have in mechanisms, or in documenting changes for teaching purposes or for publication. Many excellent doctors are treatment orientated rather than mechanism orientated, and the tests which are used in the evaluation of treatment may not be the ones used for diagnosis.

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