Free Doctored by Sandeep Jauhar Page B

for any subtle abnormalities. When I informed him of the nurse’s findings, he walked over to my father and, apparently examining him for the first time because the doctor looked so surprised, had him perform the exercises again. Sure enough, the numbness was reproducible, suggesting that my father only had a pinched cervical nerve, a relatively benign condition. Appearing chastened, Holman said the MRI was now probably unnecessary but advised my father to have it anyway (with the imaging extending into the neck) to eliminate any residual uncertainty. It confirmed what the nurse had suspected: a pinched nerve.
    My father was given a prescription for a neck brace and sent home from the ER. I decided not to tell him too much about the final diagnosis. I didn’t want to ratify his distrust of doctors, and I wanted to maintain a little fear in him so he’d take his blood pressure medication. The following day, he and my mother flew back home to Fargo, North Dakota, where he was then working as a plant geneticist.
    A few weeks later I was having breakfast with Tom Antoni, a newly hired cardiac rhythm specialist, in the LIJ cafeteria. In the manner of most doctors in his specialty, Tom was calm, detached, and thoughtful, and we had become friendly. I was still fuming over Davenport’s and Holman’s incompetence. If only they had examined my father properly, a $20,000 diagnostic workup and a great deal of worry could have easily been avoided.
    Of course, I should hardly have been surprised. At one time, keen observation and the judicious laying on of hands were virtually the only diagnostic tools a doctor had. Today they seem almost obsolete. Technology like MRI scans and nuclear imaging rules the day, permitting diagnosis at a distance. Many doctors don’t even carry a stethoscope anymore.
    Physicians’ exam skills, as a result, have no doubt atrophied. In a study I’d read about at Duke University Medical Center, a leading teaching hospital, residents in internal medicine were asked to listen to three common heart murmurs programmed into a mannequin. Roughly half could not identify two of the murmurs despite testing in a quiet room with ample time—hardly normal conditions. About two-thirds missed the third murmur. (Retesting did not improve performance.) And in another study at thirty-one internal medicine and family practice residency programs on the East Coast, over five hundred residents and medical students were tested on twelve heart sounds taped from patients. On average, the residents got only 20 percent right, not much better than the students. Hard to imagine such abysmal performances when physicians had only a stethoscope and an electrocardiograph machine to examine the heart.
    The impetus behind these lapses, I’d come to believe, is that doctors today are uncomfortable with uncertainty. Everyone wants a number, a lab test, a simple objective measurement to make a diagnosis. If a physical exam can diagnose a pinched spinal nerve with only 90 percent probability, then there is an almost irresistible urge to get a thousand-dollar MRI to close the gap. Fear of lawsuits is partly to blame, but the stronger fear is that of subjective observation. Doctors are uneasy making educated guesses based on what they see and hear. If postmodernism teaches that there are many truths, or perhaps no truth, postmodern medicine teaches the opposite: that an objective truth is sure to explain a patient’s symptoms if only we look for it with the right tools.
    Under a flashing art deco coffee cup, I told Tom a story that an old-timer cardiologist at NYU had once told me. A group of residents had presented to him a case of atrial fibrillation, an abnormal heart rhythm, replete with results of echocardiograms, angiograms, and stress tests. He went to see the patient and immediately noticed that the whites of her eyes had black discoloration, a sign of a potentially serious metabolic derangement. No