As we stand on the brink of what might be considered the golden age of medical technology, with robotic arms performing surgeries and artificial intelligence predicting patient outcomes, it is crucial to remember the bedrock upon which our profession is built.
My journey through the medical field has been one marked by tremendous technological advancements, from the advent of CT scans and MRI to the precision of robotic surgery.
I remember the days when anaesthetists checked patients during surgery with a finger on the neck constantly checking the pulse and manually measuring blood pressure with a hand-operated blood pressure pump; these days they have all sorts of gadgets at their disposal.
However, an incident from my medical school days stays etched in my memory, serving as a constant reminder of the enduring value of fundamental clinical skills.
During a class discussion on a patient with a possible diagnosis of gastric cancer, the topic turned to the assessment methods necessary to confirm such a diagnosis. When a professor asked for the next steps, a resident hastily suggested jumping straight to radiological tests.
The professor's dissatisfaction was palpable. He emphasised the indispensable role of history taking and clinical examination before any radiological intervention. It was then my turn to articulate the key clinical findings expected in such a patient.
To my surprise and the clear chagrin of the residents, I managed to outline these findings accurately, highlighting the importance of basic medical practices that are overshadowed in today's tech-driven environment. You should have seen me strutting the hospital halls head held high for the rest of the week.
This incident not only underscored the importance of clinical fundamentals but also foreshadowed my path in medicine. In my final year, I was honoured with a prize as the best undergraduate student in surgery, a recognition that affirmed my belief in the significance of thorough history taking and physical examination.
This approach has been a cornerstone of my practice, even as I navigate the challenges of modern medicine, where patients often seek diagnoses and treatment plans through digital images and reports sent via WhatsApp or through telemedicine consultations.
Despite the convenience and advancements these technologies offer, I sometimes feel the diagnosis is incomplete without the tactile feedback that comes from physically examining a patient.
The essence of an orthopaedic examination – to look, feel, assess range of motion and perform relevant special tests – is a mantra I impart to my students daily. In most areas of surgical practice, the approach is remarkably similar, with few modifications.
This philosophy contrasts sharply with the inclination of some younger colleagues who lean heavily towards technological assessments, sometimes bypassing the foundational steps of patient evaluation. Two patients I saw in the past come to mind. One a referral from Tanzania and another one closer to home came to see me armed with MRIs.
In the case of the first patient, the MRI report stated that she had a tumour in the thigh, but after taking her history, it turned out that her symptoms had started after she tripped and fell while walking on a wet surface; a simple x-ray later, the diagnosis had changed from a tumour to a much simpler to treat fracture of the femur.
For the second patient, a diagnosis of an ankle fracture had been correctly made, but an x-ray again was the best test to highlight the bone problem, the MRI was overkill and was never needed from the beginning. So, in these two instances, the history taken, and the relevant examination enhanced the value of the resulting tests.
As we embrace the myriad technological advancements at our disposal, it is imperative to remember that these tools are extensions of our senses, not replacements. The story of technology in surgery is not just about the machines that make our work more precise but also about keeping the human touch that discerns the subtleties beyond the reach of any instrument.
This balance between technology and traditional clinical skills is not just a matter of preference but a requisite for comprehensive patient care in this modern age.
As we navigate the intersection of traditional clinical practice and technological innovation, there is a pressing need to recalibrate medical education. Our curricula must champion a dual focus: reinforcing the critical importance of firsthand clinical skills while also embracing the advancements in medical technology.
This balanced approach ensures that emerging medical professionals are not only technologically savvy but also deeply intuitive in their patient examinations. To address the challenges of teaching large cohorts, innovative educational strategies such as targeted workshops and simulation-based learning are vital.
Our aim is to nurture a generation of healthcare providers who are as proficient with a stethoscope as they are with artificial intelligence and robotic tools, guaranteeing a comprehensive and empathetic patient care experience.
Consultant orthopaedic surgeon
