The phenomenon of mirage or how all clinical improvement is associated with new drugs and

Medicine is evolving with society

When, in the old times, people realized that they have to do more than a priest to cure a disease, then Medicine started. They appreciate the importance of taking care of the sick person as an important human act.

The knowledge of the physiological bases of disease, and the discovery of Roentgen, were another important step in the story of Medicine. But, not everything has been perfect. The astonishing development of new diagnostic tests and the technical achievement in radiology, have created the illusion that the “classical” clinical method is not useful anymore.

A proper treatment requires an adequate diagnostic process

The effectiveness of current treatments has overshadowed the importance of the diagnostic process. Doctors are seen as a mere instrument in a chain of production, always perfect if they are not distracted, always working in perfect conditions. Even diagnostic errors are still analyzed by society in terms of negligence or malpractice or under a nonprofessional behaviour. The theory of error as an accident has not penetrated the base of our society, and what is worse, the diagnosis is the younger sister of Medicine at this time. The doctors themselves have been the architects of this situation because the enormous development of pharmacology has left in a second place the improvement of the clinical and diagnostic process.

We need the complete map, not just the islands

In recent years clinical practice has been surrounded by concepts such as patient safety, quality control, improvement of diagnosis, clinical simulation, but in a way we have forgotten the main objective of all our activity, learning from clinical practice and trying to improve it Medicine is a profession of permanent study, but only by studying we do not reach our objectives, we must focus on what we do every day. In short, we need a new orientation of medical practice that is focused on the clinical process itself and that establishes a new way of working, planning, detailing the critical points, establishing objectives, analyzing the results. That is why the methodology of improving the diagnosis must be included in a broader concept of quality improvement, in order to be able to use all of its methodology. Medical schools are devoted to teaching pathological entities, but the clinical practice is evolving rapidly, and the framework is nor more complex. Improving diagnosis is a path to practice a better Medicine, but we have to establish a methodology based on quality improvement, to be able to measure our actions.

Recover a renewed clinical method: opening the eyes to problems

The anamnesis and physical examination, together with an adequate process of clinical reasoning, are the cornerstone of clinical practice. New concepts such as the “system” in Medicine, planning, patient safety, medical error, patient preferences, problem-solving techniques, must be now integrated in the medical curriculum.