"Health & Medical News"

In the fall I rotated through the geriatrics ward. One of the attending physicians was an irritating woman whose idea of the Socratic method was pimping you with really vague questions, then acting like she had already thought of whatever answers you gave and that you were only telling her what she already knew. The other attending was a throwback to “the days of the giants,” when pneumococcal pneumonia was diagnosed by injecting sputum into mice and antibiotics for urinary tract infections were tested on agar plates. One morning, one of my interns presented a case to him of an elderly man who had been hospitalized with fever and a cough producing green sputum. “He has pneumonia,” she proclaimed confidently. “Take a look at this chest X-ray.” She pulled up a digital image on a computer screen showing a distinct pneumonic streak. The senior physician waved it off. “First tell me about your lung exam,” he said.

It was a common scenario on the wards: young doctor ignoring physical examination to the chagrin of an older and wiser counterpart. At one time, keen observation and the judicious laying on of hands were virtually the only diagnostic tools available to a doctor. Now, on the wards, they seemed almost obsolete. Technology — ultrafast CAT scans, nuclear imaging studies, and the like — ruled the day, permitting diagnosis at a distance. Some doctors didn’t even carry a stethoscope.

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