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Friday, 4 August, 2000, 09:32 GMT 10:32 UK
Our medieval medicine
Dr Colin Thomas
BBC Doctor Colin Thomas gets all old-fashioned
BBC Doctor Colin Thomas on ancient tricks and tests still serving modern doctors well.

"What's the reason for asking me to say "99" doctor?"

I get asked this often and I launch into my well rehearsed speech about transmission of sound through gases, solids and liquids.

Quite a scientific explanation really, and although patients nod approvingly I suspect they are none the wiser. However last week I asked myself the same question.

"Why do we bother getting patients to go through 300 year old rituals when science and technology have advanced so far? And I'm afraid I was lost for an answer.

There's no doubt that these techniques are still valid, but what, I thought, am I doing in today's technological world with a piece of rubber tubing stuck in both ears and a drumskin on the patient's chest?

Another examination technique we are taught is percussion of the chest - that's tapping a finger from one hand placed on the chest wall with the middle finger of the other hand.

The best explanation I ever got at medical school was akin to tapping a beer keg to ascertain how full it was. Resonant above the beer, but dull when you reach the fluid level.

Garage treatment

So the basic physical examination hasn't changed for centuries. I'm sure the 'old school' purists would say "jolly good thing too", but imagine taking your Ford Fiesta for a service to be told it needed four new horse shoes all round.

You wouldn't be best pleased. (Although I am reliably informed that mechanics do still use a stethoscope for particularly tricky engine diagnoses!)

So you'd probably find a 17th century doctor quite at home with the clinical examination side of medicine as it stands today, but of course all the diagnostic tests would be considered as witchcraft.

However it is precisely in these 'witchcraft' areas in which the advances of medicine have occurred, but very little has encroached into the basic physical examination.

This will change. Old techniques will have to be replaced with new, as in other professions and trades, but I believe more likely now by revolution than evolution. In the consultation of the future I think patients will interact with a computer programme before seeing the doctor which will objectively assess the patient's symptoms and provide a list of possible diagnoses.

Doctors will then run a set of table-top diagnostic tests which will give a near instant diagnosis for most conditions.

Specialists in hospital will inevitably hide behind even more complicated equipment.

Of course the old style bedside manner will change somewhat as doctors become masters of technology rather than artists.

I'm sure we will realise that there are better ways of assessing patients than half empty beer barrels.

Doctors of the future will look at my rubber tubes and think: "How quaint" in the same way we smile at physicians of the past who applied leeches to suck blood.

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