That mainstay of medical diagnosis and of the doctor patient relationship, the annual physical history and examination is under attack. The mandarins of medicine have decided that vital part of medical practice, the complete history and physical examination are non productive and too expensive to be universally applied. Very sad, because for generations that consultation was the base of the pyramid of medical care. There, the patient had an opportunity to voice his or her concerns to the physician, whether logical or not, have a hearing and an opportunity to determine whether the concerns were grave or not. The doctor got to know the patient and the patent got to know the doctor. The patient and doctor get an opportunity to decide if they are a good fit for each other and if their relationship is productive. Every patient is an individual and requires some difference in approach and possibly differences in therapeutic approach. The bureaucracy wants to make everyone the same, except of course, themselves and the elite that they serve. Most of them have a background in finance and business and knew nothing about medicine until they entered the political arena, after which they pooled their mutual ignorance to become self designated 'experts'. They also decided that this was not only a good money making career, but possibly an entry into politics and a very rewarding way to garner votes. They were prepared to make unrealistic promises that they thought they could bully a humanistic profession to make and they were right. Early on, many physicians seemed quite happy to go along with promises the administridiots were making because it made them look like heroes too. Unfortunately, it was not long before it became apparent that the bureaucracy wanted the kudos of providing health care at no costs to themselves. In other words, they wanted the jobs, the pensions and the votes that a world class medical service would enable without doing the work or providing the services. They wanted to gain their fame and fortune on the backs of physicians and nurses. Shamefully, the bodies who should have been looking after the interests of both physicians and patients were timid and ingratiating and served neither the best interests of physicians or patients. The game is still being played and choosing wisely, a program that could be valuable in helping to define what consultations, tests and investigations are being used unwisely is discouraging that inexpensive baseline of medical practice, the complete history and physical examination.
No wonder Canadian medicine ranks eleventh out of twelve in the developed countries.
Tragically, the Canadian public bury their head in the sand instead of demanding change. Things can only get worse!