Laugh all you want, but I am a NASCAR fan. I love watching the near 200 mph bumper to bumper racing, all the left turns, the pit stops and of course the wrecks! I always get dirty looks when I mention how much I like it, but my reply is always the same – unless you go to a race, you have no appreciation for what they do.
Many years ago, when a cars engine would “quit,” the team would gather in the pits and try to “diagnose” the problem. They would gather as much information as they could. This included interviewing the driver to find out what he saw inside the car – was the water temp above normal, the oil temp spiking or did he hear something abnormal? They would pop the hood to look from above and get on the floor to look from below. They would piece together all the parts that broke apart, trying to recreate the incident, to figure out where the failure started so it could be prevented in the future.
The more you read that last paragraph the more you can start picking out what sounds like a normal, in-depth history and physical. Interviewing the driver, same as interviewing a patient. Gather a good history of present illness. What did the patient feel, what did the patient see? Examining the broken parts and trying to put it all together – putting hands on the patient, doing a thorough exam and building a differential diagnosis. Together with some pertinent targeted labs and radiological studies, you can come to a diagnosis.
Does that patient scenario sound familiar? It sure does. It’s what you read about in a textbook. Nowadays, a patient comes in with a chief complaint and they are wisked off to the CT scanner, or there are “normal, ROUTINE” labs that are automatically drawn when a patient steps into the ED.
Would you believe that the same transition has occurred in NASCAR as well? No longer do the teams need to talk to the driver, no need to “lay hands” on the car. Now they just plug in their laptop to the diagnostics port on the race car, the same port that the car parked in your driveway likely has. The car’s computer now logs everything: speed, temperatures, RPMs and all other electrical data. That data is downloaded and interpreted to diagnose the malfunction.
If it works for NASCAR why doesn’t it work for people? Unfortunately we can not just throw up our hands and say, “Well, it works for them!”. The cost associated with plugging in a laptop vs. sending a patient to an unnecessary CT or MRI scan is not comparable. The radiation associated with CT scans and X-rays can do harm to a patient. There is no harm in plugging in a laptop, other than wearing out the connector. Private advertisers pay for race cars to be fixed, but tax-paying Americans are paying a large chunk of the medical bills for the underinsured.
Physicians need to stick to their roots: use the skills taught to them in medical school, skills they honed in residency and perfected as an attending. The human touch does much more than help you diagnose disease; it instills trust and builds a relationship with your patient. Sometimes, it’s the reassuring touch that helps that patient the most!
