Health and Psychology

Laboratory medicine: blood tests, urine analysis, imaging, scanning, x-rays, biopsy are all relatively new in the field of medicine. Clinical medicine goes back to when laboratory medicine didn't exist. Clinical medicine involves looking at people and really noticing them and understanding how medical illness presents clinically. That understanding allows a physician to order the correct lab tests, images, scans, or biopsy a tissue or growth. Without clinical medicine, it's difficult for a physician to know what to do.

Back prior to 1980 or so, before managed care dramatically changed how medicine works, a physician would take a history and do a physical examination of the person noticing what they look like, how they move, and take their pulse for a minute or so. They would talk to the person and listen to what the person said was going on and what prompted the visit. the visit would last 30 minutes to more than an hour and would include a consultation at he end of the visit to review the plan. They would then, on the basis of that clinical evaluation, order needed tests.

Switch to today. A nurse or medical assistant will take vital signs and enter them into a computer. The nurse or medical assistant will record in notes what the patient says is wrong and/or the reason for the visit. The physician will meet with the patient for 5 to 15 minutes. The computer will prompt any issues based on the vital signs and will suggest tests. The physician, especially if they are younger, will order a shotgun approach to diagnostic laboratory tests-blood work, urine analysis, maybe an x-ray. In many cases the patient never disrobes. In some cases the physician never looks up from the computer screen. If a lab test comes back positive they will order more tests.

The field of medical psychology was conceptualized in the early 1980's to allow psychologists trained in clinical medicine to assist physicians in their office with taking histories and assisting with documentation of symptoms and noting clinical medicine signs. In the 1990's the field of medicial psychology changed to include health psychology and to focus on compliance with treatment and coping with chronic illness and health improvement. The field of clinical medicine was left behind.

A recent medical article (Improving Diagnosis in Health Care from the Institute of Medicine) estimated that there is a 5% error rate in diagnosis at outpatient visits.  10% of these errors are serious enough to result in death.  17% are serious and life changing.  Virtually everyone can expect a medical diagnostic error over the course of their lifetime.    Clinical medicine reducess error rates.

I'm in the process of writing a book on clinical medicine for therapists.  So far it's 50 pages in length and covers taking a history, doing a mental status exam, and looking at the skin and hands.  Physicians need to be trained in clinical medicine in order to make laboratory medicine work well.  If they can't perform clinical medicine evaluations because there are too many constraints oon their time, then maybe it's time to bring back medical psychologists with clinical medicine training.