Physicians and the Art and Power of Observation - Has This Bird Flown?

Medicine is for the birds, or it should be.  Hear me out.

A day before I wrote this, I was on the trail in northwest Ohio, binoculars in hand, trying to tell one warbler from another.  This was the final weekend of The Biggest Week of birding in Magee Marsh on the shore of Lake Erie.  Birders converged here from neighboring states and even from foreign countries to participate in this ornithological adventure.  My companion and I were new to the game.  Indeed, my birdwatching prowess had consisted of being able to successfully identify a blue jay at the feeder on our deck.  I had now entered a different universe.

There were serious birders afoot equipped with photographic and telegraphic equipment that looked like stuff that James Bond might have used.  Birds flitted about that heretofore would have generated no interest on my part.  When a rare warbler was spotted, the excitement raced through the birders like a brushfire, causing a crowd to gather to view the feathered phenom.  And, there were polite disputes among experts who were debating the true identity of the creature before them.  All in all, this was good clean fun.

Birders need knowledge and patience.  In addition, the most accomplished among them must have discerning powers of observation.  Here’s how I spotted a bird.  I simply came upon real birders who were all aiming their scopes and binoculars in one direction, and then tried to spy their target.  The skilled birder, the first on the scene, does not have this advantage.  He carefully scans the trees and foliage trying to find small birds, which are obscured by leaves and branches or camouflaged.  This looks easy, but it isn’t.  Many times, I had trouble finding the bird even when several birders next to me were staring at it.  This didn’t ruffle my feathers as I knew I was a few rungs below the beginner class.

You have to know what to look for, which is the distinguishing skill.  The pro knows the flora and which birds are likely to hang out there.  He sees the subtle moving of a small branch and knows this is not from the wind.  He knows the birds’ voices as individual arias, not as idle whistling.  He tunes out the visual and auditory static.

Easy to Spot 

Not so Easy

The power of observation used to be a honed skill of the medical profession.  Prior to the takeover of the profession by medical technology, physicians could deduce much simply by carefully observing the patient.  While medical educators may state that this skill is still valued, taught and practiced, this quixotic view isn’t part of the reality of medical practice today.  During my days in medical school, I recall learning from experts who could ascertain important medical information by examining a patient’s fingernails.  Palpating the pulse, and appreciating its nuances and subtleties, was an art, and not simply a means of determining the heart rate.  As a medical student, I watched Proctor Harvey, a giant in cardiology, use a stethoscope to hear sounds and make accurate diagnoses that are beyond the skills of nearly all of today’s physicians.   A patient’s speech, gait and skin often held important clinical clues for the physician detective.

I don’t’ think that medical quality is worse today because today’s physicians are not trained to observe.  Instead of observing, we test.   Nearly every heart murmur is subjected to echocardiography, as but one example.  The consequences of overtesting has been overblogged here at MDWhistleblower.  Readers know my serious concerns about overdiagnosis andovertreatment. Technology has both raised and lowered medical quality in this country.

I am wistful when I recall physicians and teachers from two generations ago, who could solve a case with their eyes and ears.  They would have been incredible birdwatchers.