Thursday, March 31, 2011

After Reading Chapters 3 and 4 in EPTAS

1. Dr. Sanders mentions several "unintended consequences of good medicine." Please pick one and elaborate/explain.
2. Dr. Sanders mentions the power of touch. What does she say about touch, and do your own experiences resonate with what she says? This article from 2006 explores a different aspect of touch, medicine and the immune system. Taking both of these perspectives into account, if you were designing a training program for doctors, what might you have them do to prepare them for touching their patients?
3. The final statement in chapter 4 is very charged. Please address and assess Dr. Sander's assertion.

25 comments:

  1. 1. good medicine has resulted in a decline of many diseases, complications and deaths. but, interns now do not get to examine a patient with the disease as they are learning but they may be required to identify the disease in their further experiences. this is the case with rheumatic heart disease. it use to be very common and doctors would be exposed to the sounds the diseased hearts made. but now the disease has almost been eradicated. so many interns will never have patients with this disease but might have to diagnose the disease at some point in the future.
    2.i agree with her assertion regarding the power of touch. touch is definitely used as a communication too in everyday life. but it would definitely initially be uncomfortable as a doctor being expected to perform procedures that require touch in "taboo" areas.
    I think an emphasis in a class on the doctor patient relationship would be beneficial to prepare doctors for touching their patients. but, i think the best way to prepare for touching patients is practice. whether it be on plastic models or real people.
    3. I think dr sanders is really alluding to (maybe unconsciously) our society's affinity and overwhelming trust in technology. we think it can't lie and will never be wrong. this might be true but it doesn't always tell us the truth either and when we get that point we are stumped and dont try something different. i can't really talk about the importance of the physical examination because i have no experience or medical knowledge but the article and the book we read are both obviously for the physical examination. not even on the medical level, but just the human interaction the physical exam provides ensures a sense of comfort are for that reason is beneficial. i think by doing physical exams medicine becomes less removed, which is part of the point she made earlier that patients aren't just broken and need to be fixed but that they are people with their own stories.

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  2. 1. Good medicine is defined by Sanders as the use of technology. The one disadvantage she outlines the most is the loss of touch, and, maybe even more significantly, the loss of a significant bond between the patient. Physical exams, she repeats to the point of death, are dead. Why bother to listen to lungs when a machine will analyze it for you? Obviously, machines don't talk back, so patients lose the 1 on 1 trust with their doctor that they many enjoy. This loss of trust has made it significantly harder to "sell" stories to patients and even to treat them.

    2. The article and the book both deal with the type of touch where there is a trust between them. The article cites examples of husbands and wives, and trusted doctors helping and stimulating people/babies. This can only exist through a constant physical contact. This ties back into the trust thing. Physical contact means nothing without at least an understanding between the two parties.

    That and the medical school stuff. But that'll be below.

    3. It seems as though Sanders really critiques the application of modern medicine as it is practiced. I think that this may be a little flawed for a few reasons.
    Her "offense" against the technocratic idealism of medicine involve stories of scans not showing vital signs that would have saved a life. I will agree that sometimes there is NO replacement for a machine, but a lot of the time there usually is a test that would do the same thing, but the human contact is faster. The reason why people die is because they DIDN'T scan that heart tumor, etc. Now I'm not saying scan everything, but it seems that if someone comes into the ER with a weird heartbeat, it might be a good idea to at least look at the heart a bit.

    Second, this seems like trying to terrorize people with stories. Obviously people use technology because it works. Sanders even cites several examples of how modern medicine has reduced the rates of death. Technology provides a way out, an easy one, but still a way out that provides a clear direction of diagnosis. Obviously it has its downsides, but that's not a reason to reject some parts of it.

    It does seem that it would be necessary to have at least a generic scan, if even to locate some of the sources of the problem. It might be a little troublesome if interns that can't tell a diseased heart rate from a normal one. But that's not a reason to get away with technology.

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  3. 1. One unintended consequence of good medicine is that patients typically spend less time in the hospital. This is made possible by advances in medicine, and fueled by the desire to make treatment as inexpensive as possible. Because of this, residents, interns, and students have much less time to spend with teaching cases, and therefore have less experience.
    2. Dr. Sanders says that touch and physical examination are very important in medicine despite technological advances. She also talks about how hard it is as a doctor to feel comfortable touching a patient. If I were designing a training program for doctors, I think that it would be really important to give students enough practice and training that they felt confident and comfortable touching patients, because if a doctor is uncomfortable, then the patient will feel that and be uncomfortable too.
    3. I agree with Dr. Sanders that the physical exam is still necessary even with advances in medicine and science. Clearly it has the power to speed up diagnosis and give clues that a machine can’t necessarily pick up, and therefore it should be used along side technology.

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  4. 1. If good medicine is defined as the use and reliance upon technology to make diagnoses, then Dr. Sanders emphasizes the death of the physical exam as an unintended and unfortunate consequence of the latter. Before the technology boom, the physical examination used to be the key method to producing a diagnosis. Not only did the physical exam allow the doctor to learn more about the sounds or feeling of a specific human body compared to an ideal one, but it also encouraged a closer patient-doctor relationship. The physical exam is a difficult skill to master; it is never easy or comfortable for a doctor to touch a stranger's body, nor is it comfortable for the patient to be touched by an unfamiliar doctor. "Good medicine," in essence, is robbing doctors of this skill; relying on technology to supply them with the correct answer has allowed them to become lazy and has created an almost impersonal ambience in the hospital. People today have been brought up to believe that technology never fails, and it is true that a judicious use of technology has allowed for a significant decrease in deaths. However, Dr. Sanders gives several examples where the physical exam may have saved or did save patients when technology could not.

    2. Despite some of the unclear/indefinite results of the experiments described in the article, patients whose treatment includes human touch appear to have greater health benefits than those who aren't touched. Dr. Sanders as well points out a few cases in which touch ends up being the key to solving a medical case. However she also discusses the awkwardness doctors may experience when touching a patient. I believe that this awkwardness comes from a lack of experience. I would simply have them practice as much as possible, as students at med school and then as interns, until they become comfortable enough to face their patients, until they learn the bumps and sounds of a healthy body so well that they can more easily spot any inconsistency. When I had appendicitis I do remember being briefly examined by an intern and then later the surgeon before being sent up for a CT scan. If I remember correctly both exams were relatively quick and not very awkward; it just seemed like a routine. The doctors themselves didn't really say much, but I was in too much pain to really care. I believe that if a patient does show any signs of discomfort towards being examined it is the doctor's job to be able to tell the patient where they will be touching them and why.

    3. After having read the article and Dr. Sanders' point of view, I do believe that the physical examination, or simply the act of touching, is much more beneficial than it is detrimental. If it is possible to discard parts of the examination that might not be effective to make the exam "leaner but keener" I believe that more doctors would be willing to examine their patients physically. However I do not see why the physical exam must be completely dismissed if it cannot be pruned. The physical exam has proven to be a benefit for the patient as well as the doctor; it is quick and yet also creates a more personal atmosphere as well as developing a useful skill for the doctor and potentially saving the life of the patient. There seems to be no true downside except for the initial awkwardness which with practice and time both the patient and the doctor can learn to overcome.

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  5. 1. I think the most obvious and scariest consequence of "good medicine"...or technologically advanced medicine...is the "death of the physical exam." Without the physical exam being the first "go to" interaction between a doctor and a patient, much of the patient-doctor relationship is undermined and that fundamental and necessary trust is going to be that much harder to build. Along with a lack of trust, Dr. Sanders mentioned how there are symptoms and abnormalities that could be noticed without tests if the doctors, residents, and med students simply took the time with their patients to make sensory observations.

    2. I think Dr. Sanders is right when she expresses how important touch can be but that even doctors can still feel uncomfortable when dealing with “private” areas. As for my own experience, I think my level of comfort is completely dependent on how professional, friendly, and comfortable the doctor is, or at least behaves. When reading the article what really stood out to me was when it mentioned that, "if you touch your partner they feel relaxed, but if someone else touches them they may not feel as relaxed." I think this reaction occurs because couples have a certain level of comfort with each other and their relationship. They know their partner is looking out for their best interest and so they trust them and even feel safer because they have them there with them. It also mentioned that “Dr. Matthew Hertenstein discovered that touch communicates emotions. When people who were touched by a stranger they could not see, who had been instructed to try to communicate a particular emotion, they were able to tell the emotional state of the other person with great accuracy.” This is what I think is one simple yet vital aspects of doctor-patient relationships that could be improved with the physical exam. Doctors already have such a short time to basically mimic a long-term relationship with their patients to make them feel comfortable, that by also cutting out the physical exam, they are only undermining it further. So if I were to design a program for doctors I would try to design a class that helped doctors gain the tools they needed to develop those quick doctor-patient relationships, in order to make their patients feel as if they had known the doctor as long as they may have known a loved one, and feel like their doctor is advocating for them in the same way.

    3. I think Dr. Sanders is right to say that the physical exam is important yet flawed. It makes sense that the physical exam could be improved and become “leaner and keener” but I’m not exactly sure how she recommends improving it. I also don’t totally understand these dramatic accusations that “if we don’t improve the physical exam it will be lost,” because at least from my experience I still experience the physical exam at every doctors appointments. So it seems fair to say that it is definitely in need of improvement but I also think it is exaggerating it a bit. It seems to me that what is more in need of improvement is the amount of time doctors are spending with patients, or lack there of. It also seems pretty subjective to go about deciding which parts would be kept and which would be gotten rid of. If doctors can’t even agree on the issue of whether or not the exam is important, how will they agree on what the important parts of the exam are?

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  6. 1. One bad consequence of good medicine is that the typical stay of a patient in a hospital has shortened. This has been made possible my more effective medicines, and has provided less time for students to practice on real patients. This shortened amount of time leaves a smaller amount of experience for the people who will become doctors.
    2. I think that her opinion on the use of touch in medicine is a correct one. Touch is used as a tool for communication in normal life, but the importance of touch in medicine should not be overlooked. But it would be uncomfortable as a doctor-in-training to be performing a physical exam and be expected to touch areas that most consider taboo.
    To better prepare the future doctors of our society, I would suggest simply increasing the amount of exposure the doctors have to physical exams. This would better prepare the future of our hospitals.
    3. I feel that the physical exam should still be continued to be practiced alongside new technology. Dr. Sanders says that the advances in medicine can still not void the amount of benefit the physical exam can give us. The exam should be used alongside technology in my opinion.

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  7. 1. An unintended consequence of good medicine that Dr. Sanders mentions is that the amount of time a patient spends at a hospital has significantly been shortened. The main reasons for this are expensive hospital costs and effective medicine. This has decreased the amount of time that students have to get to see symptoms and diseases of real patients so they can identify those diseases in the future.

    2. Dr. Sanders mentions the power of touch. What does she say about touch, and do your own experiences resonate with what she says? This article from 2006 explores a different aspect of touch, medicine and the immune system. Taking both of these perspectives into account, if you were designing a training program for doctors, what might you have them do to prepare them for touching their patients?
    Dr. Sanders says that touch is the way we understand people and communicate, whether it’s an embrace or from a lover or children. There are certain social boundaries for touch, and doctors would violate those “rules” in a social setting. But doctors do need to use touch to make sure the patient is healthy and they learn to treat each body part individually and more objectively to make it more comfortable for the patient and more effective in their diagnosis. If I had to design a training program for doctors, I would have them do a structured physical exam. This could be done with cadavers or manikins, but would emphasize touch but making sure the patient felt comfortable and good about it. Otherwise it won’t have a good effect as the article said. Dr. Sanders said there isn’t a structured physical exam training, so this would probably be a good idea.

    3. Her assertion makes sense. If the physical exam is that important and should be continued then medicine will lose a valuable tool if it keeps getting deemphasized. Dr. Sanders has provided many examples that illustrate how quick a doctor can effectively diagnose a patient using the physical exam while special tests could take quite a while (especially if there’s multiple).

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  8. 1. One unintended consequence of good medicine is the decline of patients with diseases that doctors wiped out a while ago. This means that because doctors were able to almost eliminate a disease, new doctors don't have experience with that disease, so when one rare patient does have it, the doctor cannot recognize the symptoms as quickly as he or she needs to.

    2. Dr. Sanders says that touch is initially very awkward for the doctor, but that in many cases it is essential in the diagnosis of a patient. Sometimes certain lumps won't show up on tests, but a quick pat-down of the body will make those lumps obvious. I definitely agree that doctors touching patients excessively is awkward, but I think if the doctor tells the patient exactly where they are touching and why, and does not elongate the process, I wouldn't personally feel awkward, and I think that would probably be true of most people.

    3. Dr. Sanders says that if we continue practicing medicine as we are right now, eventually the physical exam will be completely lost and many patients will die as a result. I definitely think this is true, and I think that bringing back the exam is easy enough that it really shouldn't be as much of a problem as it already is.

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  9. 3. Sanders’ belief in the physical exam as a valuable diagnostic tool is well-argued in the two chapters. If it is indeed true that one in four hospital visits could have been resolved with a simple physical (that might not have been the exact statistic), then I believe that it is absolutely worth a doctor’s time to perform a physical. I do not know how long the average physical lasts, but I don’t think it would be longer than fifteen minutes. A 25% chance of saving expensive tests and an extended hospital visit is well worth fifteen minutes in my opinion. I also agree with the sentiment that the physical exam should be streamlined. Those parts that can be removed are the sections of the exam that consistently yield inconclusive results and could even be harmful to the patient, sending doctors in pursuit of a red-herring symptom that might have been eliminated by more extensive testing. Streamlining the process might also make reluctant doctors more likely to perform physicals, as they would take less time out of their purportedly busy schedules.

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  10. 1)
    Before good medicine, strep infections used to be much more prevalent. Doctors did not have good ways of treating these infections. One severe effect of strep was an autoimmune response in which the body attacked the heart valves, leading to rheumatic heart disease. Because of how common this autoimmune response used to be (before good medicine reduced the pervasiveness of strep), doctors had lots of experience listening to strange heart murmurs. Now, because of "good medicine," doctors do not encounter strange heart murmurs nearly as much, and as a result they have gotten worse at listening to the heart to detect disease.

    2)
    Sanders says that touching patients is a very powerful tool for detecting whether the structures of a patient's body are healthy. For example, doctors use touch to spot breast cancer and other forms of cancer. However, Sanders says that it is very awkward and uncomfortable to touch patients in "private areas" to look for diseases. The article says that touch is important psychologically and that people have important and beneficial responses to touch. Thus, I think that doctors should be educated more about touching patients, and, as part of their training, actually touch patients more often to look for disease, so that they fell comfortable using touch to search for disease and to "connect" with the patients.

    3)
    Sanders says that the physical examination is on the decline because of the rise of technology, and that without the physical exam, medicine will become more expensive and less effective. Sanders has built up a very strong case in support of the physical examination, showing how it can pinpoint diseases that tests fail to spot. However, I also think that tests can probably pinpoint diseases that the physical exam cannot spot. Perhaps the physical exam should be the first source of information that doctors turn to, but tests should also be used a lot when the doctor is not sure of him/herself and wants to confirm or find new explanations.

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  11. 1. Sanders includes the use of technology in her description of "good medicine." Although we believe technology to be flawless and reliable, it often causes more problems than it solves. Technology is a useful tool, but often it would be better for patients to have exams directly with doctors, because doctors can catch some problems that technology cannot. As another unintended result, there are shorter and fewer doctor-patient exams. In some ways this limits the capabilities of doctors, because they are no longer connecting with patients. As a result, patients often have less trust in doctors, and doctors are less connected to patients.


    2. Dr. Sanders says that touch is an important aspect of doctor-patient relationships, and often touch is powerful enough to save a patient, or at least make a better diagnosis. However, doctor-patient relationships can be awkward, especially considering they are strangers. One problem is when doctors or patients are nervous or scared, the problem gets worse. To combat this problem, it would be better if doctors were more experienced and behaved in a confident and professional manner that made everything seem routine - this would make patients more comfortable and the whole process more easy.

    3. Dr. Sanders ends with a critique of reliance on and excessive trust in technology and an emphasis on the reliability of physical exams, a theme which has been heavily examined in the chapter. Although I believe she has a point, with any thing a healthy balance is necessary. We have seen examples when technology has caught problems that doctors could not and when doctors catch problems that technology could not.

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  12. 1. One unintended consequence of good medicine is the increase of inexperienced doctors. Because patients are treated for and cured from their ailments rather quickly, therefore spending less time in the hospital, doctors do not have enough time to examine their patients and become familiar with the illness inflicting the patient. Over time, inexperienced developed among doctors: even residents who have practiced medicine for several years did no better at identifying problematic heartbeats that did first-year interns.

    2.Dr. Sanders stated that touch is an intimate and personal experience between people and points out the unavoidable awkwardness between doctors and patients, who are usually complete strangers. Despite that, in a medical sense, touch is one of the most basic and effective methods of diagnosis. She lists several cases where touch ultimately solved the "mystery illness" patients suffered from.
    If I created a medical program, the way I would help the students get pass the awkwardness by having them examine each other. Presumably, it would be awkward for a peer to touch you, so by doing that, they would be more comfortable when the time comes to examine an actual patient.

    3.I agree with Dr. Sanders' final assertion in this chapter that physical examinations are dying. Using the cases she lists in the book, physical examinations are shown to be very quick and reliable method to diagnosis patients were technology had failed.

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  13. 1) one of the unintended consequences is the lack of experience doctors get to face with certain diseases. Because of technology and an increase of early stage/pre disease diagnosis’ doctors no longer face certain diseases as often. This causes them to have more difficulty making the diagnosis and these diseases and be less prepared for the disease in general.
    2) Dr Sanders says that touch is a very important part of making a diagnosis as it can lead to finds that technology could not make. However, she also says that it is an awkward experience for both patients and doctors. I agree with her in saying that it is very awkward, but I acknowledge that it could potentially save my life. I think to prepare doctors for touching patients, I would make them practice it more; I do not think many doctors have to go through it as Dr. Sanders only did it once, and I don’t think many teachers would put themselves out there like her teacher did. I think the way a doctor handles himself or herself around a patient is also very important. By practicing it, a doctor is more likely to stay composed and calm and say/explain whatever needs to be said, allowing the patient to trust their doctor more and stay calm as well.
    3) Dr. Sanders’ statement, while an exaggeration, is true. The physical examination is very important. However, she makes technology seem evil and dominant. While it may be dominant, it is so because it has helped medical finds greatly. Technology is more commonly used because it works very well, which she does not really mention. I think a more effective, less radical way of saying the last sentence would be something along the lines of: By using both the physical examination and technology, the chances of a correct diagnosis are more likely than either one of them alone.

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  14. 1. One of the most important "unintended consequences" of recent medical advances is that most doctors are now unable to identify symptoms related to diseases that were previously prevalent. One example of this is heart disease. Because recent medicine has drastically reduced the existence of heart problems such as murmurs, many doctors, even those with decades of experience, are unable to identify with ease even some of the most common types of inconsistencies within the heart beat. If even experts within the field of medicine are unable to identify heart problems, what hope is there for those of us who may develop cardiac diseases?
    2. Dr. Sanders emphasizes the importance of a trusting relationship between patient and doctor and states that one of the most important aspects of this relationship is touch. Touch is vital to a doctor's ability to correctly assess an illness, and without it, there's always a chance that a doctor may miss some very important clues to the puzzle. The additional article also points out the importance of touch, but as a method of healing instead of diagnosing. When there is a healthy, trusting relationship between patient and doctor, the patient will feel comfortable allowing the doctor to touch him or her, which will in turn aid them both. In med school it's important for future doctors to be trained in the use of touch with their patients, because if they continually practice touch it will eventually become second nature.
    3. Although Dr. Sanders's final statement is very strong, I wholeheartedly agree with it. If the medical system evolves to disregard completely the physical exam as a method for curing patients, it will harm everyone involved in and affected by the world of medicine. As Sanders says, it will be not only less effective, but also more expensive as many additional tests will be run whose results will only show something that could have easily been discovered through a physical exam. Physical exams are necessary because they give sometimes blatant clues as to what is wrong with the patient, so doctors shouldn't completely disregard their use.

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  15. 1. Good medicine has resulted in many diseases being caught early, before more severe symptoms develope. For example, today's medicine has lead to a major decline in the number of deaths caused by rheumatic heart disease. However, the disease has not been completely eliminated, and doctors are still required to recognize the symptoms. Because of the large decline in the number of individuals affected by the disease though, there are fewer cases that allow doctors to learn the symptoms.

    2. Dr. Sanders emphasizes the vital role that touch plays in a doctor-patient relationship, as it is an essential aspect of making a diagnosis. I found her insight into touch, that "the patient will let the doctor see him and touch him and in return the doctor will share her knowledge for the benefit of the patient" extremely accurate. In my experience, however awkward it might be, I've always willingly allowed my doctor to touch me. I know that it's soley for the benefit for my health, and that makes me trust her. The article discusses touch as a form of healing versus diagnosing. I think that if med school emphasized touch as a form of comfort between doctors and patients, instead of simply a method of diagnosis, students would learn to build more personal relationships with their patients that would ultimatley lead to a more accurate diagnosis.

    3. Dr. Saunders's assertion seems accurate to me, although my only evidence is what she has presented in her book. Assuming it's a fair assertion, I'm completely in agreement with what she has to say. I do believe that our evolving technology will allow doctors deeper insight into illnesses, but the personal connection between doctors and patients will be lost if doctors become too relient on various tests. The physical exam, as Saunders continuessly emphasizes, provides easily missed details that help a diagnosis.

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  16. 1. an unintended result of good medicine is the decline of the physical exam. The physical exam provides the doctor with information that is not always detectable through high tech modern medical tools. The lost of the physical exam would make certain problems harder to find and would result in a longer period of time needed to make some conclusions.
    2. Dr. Sanders greatly emphasizes the power of touch and i completely agree with her. physicality between a patient and a doctor creates a bond of trust that makes it easier to find the problem.If i were to design a program for medical students i would strongly encourage the importance of the physical exam. I would have the students practice on real people, or at least on dummies. I would try to have them learn how to correctly approach the patients and make them fell comfortable and confident.
    3. I totally agree with Dr. Sanders that the physical exam is very important and should not be lost. while technology is really necessary nowadays, a simple physical exam can quickly solve the problem, avoiding tons of tests and results and a waste of time.

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  17. 1. She explains that because many diseases are now caught and treated early, doctors in training have fewer chances to learn at the bedside. Thus a new system of teaching is needed.

    2.Doctors need practice touching and interacting with patients. Practice would allow them to become confident and comfortable. Doctors who are comfortable can make their patients more comfortable and less embarrassed. Being comfortable also helps doctors to gain trust from their patients, allowing for the restorative kind of touch discussed in the article.

    3.Her call for a systematic evaluation of the physical exam should be heeded. We should accept the superiority of neither technological methods nor the old-fashioned, hands-on approach without solid evidence. Additionally, we need not completely reject one or the other : we can combine the pieces that work. I agree that the components of the physical exam should be evaluated objectively to provide the best care.

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  18. 1) Dr. Sanders talked extensively about how the evolution of medicine has led to great advancements in technology and testing. This new technology, while being incredibly beneficial, has led to the decline of the physical exam. Recently, most doctors are more likely to send their patients in for testing and screenings rather than to give them physical examinations. Dr. Sanders attributes this change partly to the awkwardness associated with the physical examination. She adds that many doctors have more faith in the precision and clarity of advanced medical testing than in the somewhat subjective physical exam.
    2) Dr. Sanders believes that the power of touch allows doctors to diagnose patients more efficiently and sometimes more accurately. In EPTAS she gives an example of a complicated, uncommon case that was able to be diagnosed by the physical exam. The doctor who diagnosed the patient with West Nile virus had practiced medicine in Iran before coming to America. In Iran he did not have as much advanced technology, so he relied heavily on the power of the physical exam. Without the physical exam, the patient's diagnosis would have been very difficult to obtain. In the 2006 article, the writer talked about a different power of touch. While Dr. Sanders talked about touch as a way to obtain knowledge and potentially a diagnosis, the article discussed how touch can actually be beneficial to patients. Touch has been known to lower blood pressure and reduce fear and stress in those in pain. I believe that it is important to incorporate lessons on physical examinations into medical training programs. I thought that the anecdote Dr. Sanders gave in EPTAS about how she had to give her professor a breast examination is an excellent example of the types of scenarios students should have to experience in medical school.
    3)Dr. Sanders stated that if the physical exam was to die, the health care system would become less efficient, less helpful, and more expensive. I agree with this statement. The physical exam could spare patients the need to be endlessly tested. Obviously, from an economic standpoint, the physical exam is beneficial, but it is also beneficial to the patients welfare because it allows doctors to catch sometimes simple cases without wasting time and energy.

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  19. 1. Dr. Sanders says that with the advancement of medical technology, doctors are discrediting the value of a physical examination. This causes doctors to miss certain key symptoms that could lead to a faster diagnosis, and as a result, more patients aren't being diagnosed properly until it may be too late.

    2. Dr. Sanders says that touch, while sometimes awkward, can build a strong relationship between patient and doctor. Touch is also an important tool that doctors can use to diagnose various diseases, and the patient's trust in the doctor to properly diagnose them is key in the process. if I were to design a training program for doctors, I would make sure the doctors had ample practice in physical exams in a class setting like the breast exam Dr. Sanders recounts in EPTAS. I would also make sure that doctors got practice in real life settings such as in hospitals, and I would emphasize the importance of physical exams, that it can save both time and money (and patients' lives).

    3. I think Dr. Sanders has a point. The useful parts of the physical exam should be retained, as this could lead to faster diagnoses and more lives saved. Also, in a time when many are concerned about the high price of health care, the use of the physical exam can help reduce costs so more people will be able to afford health care.

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  20. 1. One of the unintended consequences of good medicine is the decline of the physical exam. Much of this can be contributed to the more accurate and higher quality technology that doctors use. Although technology has its place in medicine, the value of the physical exam shouldn't be forgotten. Physical exams can help diagnose a patient, and in some cases, save the patient's life.

    2. Touch, though sometimes awkward, still has its value. It helps strengthen the relationship between doctor and patient, and can also be key in diagnosing patients. If I had to design a training program for doctors, I would make sure the doctors understood the value of the physical exam, and I would have them practice the physical exam a lot so they would be prepared and comfortable when using the physical exam in their day-to-day jobs.

    3. I definitely think Dr. Sanders has a point. I think a health care system without a physical exam would seem very impersonal and transactional; I can't imagine going to the doctor and getting tested endlessly instead of just having the doctor look down my throat to see if I have strep throat or not. The physical exam helps save the patient's money and time, as well as help save lives and make health care seem more personal.

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  21. 1. One "unintended consequence of good medicine" is that so many types of illnesses have almost disappeared because of things like vaccinations. Because of this, when these diseases that have become rare do present themselves, as with the lady in chapter 2 with Lemierre's disease who almost died because so many doctors misdiagnosed and sent her home without really knowing what she had, some doctors haven't ever seen a case like it and they do not know how to treat it or diagnose it, leaving the patient untreated or wrongly treated. This is similar to the loss of the physical exam - like if there is no time to get the tests done, but doctors don't know how to diagnose just from the physical exam, they do not know what to do and in the lack of time they may not be able to treat the patient.
    2. I agree with Dr. Sanders about what she said regarding "touch." She says that touch is in everyday life a normal thing, but only to a certain degree, and sometimes doctors are forced to cross that line into a point where in regular life it would be extremely awkward. I think that in a doctor's training, it would be a good idea to just make sure that they get lots of contact with patients, so that they don't feel awkward, and seem composed so the patient doesn't feel weird either. The patient would feel more comfortable if the doctor seems to feel comfortable.
    3. I agree with Dr. Sanders when she says that the physical exam, even if maybe it should be cut down a little, is a really important part of doctor-patient interaction. Not only is it much more expensive for the patients to get tested (and if they can't afford it and there are only tests, the doctors wouldn't be experienced enough to help them out if there were only tests), but it also makes it much more impersonal. The doctors interactions with patients are important because it also helps the patient feel more comfortable that those caring for him or her will try to help, not just a computer. Also, the physical exam is quicker and more efficient, so more lives would be saved just because the doctor has time to see more patients.

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  22. One of the unintended drawbacks of modern and technologically charged medicine is the loss of the body examination. While this is the main theme of the book, it is very important in chapters three and four. In the case of Judy Reemsma, the doctor's choice to keep the lights off in hopes of soothing the patient while waiting for the useless test results, ended up blocking the doctor's ability to assess the patient accurately. If the lights would have been on, the doctor might have been able to see that her eyes were dilated, a common side-effect of ingesting the toxic plant that Judy did.

    Dr. Sanders regards touch as both a connection and a necessary diagnostic tool. Besides the fact that doctors have very cold hands, personally I can't imagine going to a doctors office and receiving no human touch. Especially having just read these chapters, it is clear to me that even the slightest avoidance of physical connection on the doctors part can be fatal. If I were designing a study program for touch, I would make sure to start off with communication skills. Before touching someone it is very important to establish the connection that you, the doctor, are a calm. nice and confident person. Once you assure that a touch examination would be greatly helpful for the diagnosis, and even soothing or relaxing, the patient should be more welcome to your touch.

    It is hardly arguable that modern technology is not useful in medicine. There might even be one day where a robot can conduct a perfectly safe and even more effective body examination than a human. When that day comes I, and Dr. Sanders, would agree that the power of a human exam should still be kept. Just as the Independent article explained, the connection between two humans is something that very well might have healing powers of its own. To ignore that would be ignorant and detrimental.

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  23. 1. Breakthroughs in medicine have lead to many diseases declining in frequency or almost completely eradicated. Because of this, new medical students are not able to see these diseases firsthand because of their frequency decrease. For example rheumatic heart disease used to be very common, but because of medical breakthroughs is no longer common. Because of this lack of patients with the disease new doctors do not know the sound rheumatic hearts make, and therefore will not be able to make a correct diagnosis given the situation.
    2. I agree about the power of touch. a person's touch can be very comforting, especially for a patient in medical circumstances. If I was a medical school curriculum advisor I would teach young doctors to use touch more while communicating with their patients.
    3. I agree that even though we do have supreme diagnostic technology, physical exams are still useful and necessary. Simple physical exams can tell us many things much quicker than our technology can and can help speed up diagnoses.

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  24. 1. One new advance in medicine is the technology used today. Although new machines and things such as robots are good for precision needed for surgery and other medical occasions, Dr. Sanders feels a loss for the normal connection between the patient and their doctor. The usual connection felt between the two is lost with the help of new technologies, and thus the trust between both is ruptured. Not only that, but technology cannot adapt to circumstances, whereas humans are able to adapt to many different environments, if their patient needs otherwise.

    2. Dr. Sanders describes the sense of touch as being powerful. In a sense, I agree and believe that touch can be extremely reassuring. Much like how my mom used to kiss my when I was injured, having a person there supporting you, even if its only your doctor, is comforting. Communication between patients and their doctor cannot be limited to just talking, but rather should extend to different feelings such as touch.

    3. Even though the power of technological advances in medicine will be great, Dr. Sanders critiques its widespread use in our society today, and for many years to come. Although technology is useful, it cannot adapt to new circumstances, as it is simply programmed to do one or a couple specific tasks, much like I said above in answer one.

    (Shellem: I already had it typed up from last week, so I might as well)

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  25. Ingrid Adamson-SmithMay 24, 2011 at 8:51 PM

    1. Sanders discusses how even good doctors (those that have appropriate boundaries especially) are uncomfortable performing physical exams. Without a physical exam, by relying solely on tests, doctors often miss vital clues that can lead to diagnosis.

    2. Sanders discusses how touch can form a bond between patient and doctor and what an important diagnostic tool it can be. However, she also talks about how touch can be awkward for many doctors. My experiences reinforce a similar idea. During a recent stay in the hospital, I was dismayed to discover how many nurses refused to touch me without gloves on—it felt impersonal. Because of that, I was delighted to see that doctors had no such qualms about touching me without gloves. It felt much more personal, and fostered a different kind of trust—when you are touched, it feels like someone is truly taking care of you. Because of all of that, I would design a training program in which doctors get a great deal of practice touching sick patients and well patients, and touching patients during physical exams and during routine care.

    3. In her final statement, Sanders is asserting that a health care system without a physical exam would lead to fewer correct diagnoses with more expensive, high-tech tests that do not necessarily do anything to help. I completely agree with Sanders – I have personally experienced how much more gets resolved when I can talk one-on-one with a doctor and have them examine me than when I am sent for test after test.

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