Diagnostics Versus Therapeutics; The Changing Role of Physicians

Prior to the 20th century, physicians themselves performed a small set of"lab tests" for their patients. One such example was tasting urine which was sweeter for diabetic patients (see:Urine flavor wheels helped doctors taste patients' pee centuries ago). Bedside diagnostic skills in these earlier days were more highly developed than today. Physicians of earlier generations thus performedall diagnostic and therapeutic functions for patients. This began to change in about the mid-20th century as the lab test menu expanded greatly and the sophistication of radiologic procedures increased. Commensurate with this shift, physicians' bedside diagnostic skills began to atrophy. Physicians caring for patients, of course, control all final diagnostic decisions and dictate all therapeutic interventions. However, what I will call the"lab/rad" contribution to final diagnoses is currently very large and will continue to increase.Regarding the lab/rad contribution to final diagnoses and considering clinical pathology (CP), diagnoses are generally not rendered but rather key test results are reported that lead to final diagnoses. For anatomic pathology (AP), pathologists have always rendered precise diagnoses. Radiologists report"impressions" which continue to be more precise and, in many cases, actually constitute diagnoses. We are now on the verge of the rendering of definitive diagnoses in CP with increasing sophistication in molecular and genomic di...
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