Inside the system
Is the art of medicine dying, as some say? Are detailed physical exams, such as percussion, palpation, and a thorough neuro exam, now just decoration for teaching rounds and medical school OSCEs? They are also hard to fit into a workflow that rewards seeing as many patients as possible in a limited time.
Meanwhile, the ED hands us CT scans, ultrasounds, and panels of blood work, almost always including troponin, BNP, and d-dimer, and a pocket ultrasound can now answer at the bedside what once took a consult. When a patient arrives with a CT chest already done, how much does my auscultation weigh against it? Will I withhold antibiotics because I didn't hear rhonchi? What is the role of my grade 2/4 diastolic murmur when an echo is already on its way?
For a clinician who takes pride in bedside skills, this can feel like a loss. The classic teaching is that the history drives most of the diagnosis, with the exam and tests refining it. But pride in the old way of working shouldn't outrank what serves the patient. Put yourself in the patient's chair: if you had new neurological symptoms, you would want a careful exam and, if the exam couldn't settle it, an MRI. Patients deserve the same.
Who pays?
That is the one-sided case. The harder question is who foots the bill for the CT chest and the echo when a quick bedside exam might have been enough. If a patient pays privately and understands the risks of testing, the ambiguity of results, and the clinical dilemmas that follow, that is largely their choice. When Medicare, Medicaid, or a private insurer pays, a line has to be drawn somewhere. Otherwise costs and resource capacity become unsustainable, and low-value testing crowds out care that matters.
None of this discounts the clinical exam. Without it, medicine is blind. Even the most test-driven clinicians use the exam to decide which tests to order. But when the picture is ambiguous, I will use the tools at my disposal, because my promise is to treat every patient as I would treat my own family. The exam has a huge role, but pride shouldn't stand between a patient and standard care.
The same argument, now about AI
The same debate is happening around AI. Some see it as a downgrade, even a source of shame for physicians, who are used to being proud of their knowledge. Much of that knowledge was built in an era with no pocket references and no internet. AI tools have only been widely available for a few years, and some colleagues hide their use of them because of that stigma. I think that is the wrong approach.
Like the echo, the CT scanner, or the stethoscope itself, AI is a tool. If it helps you care for patients better, use it openly, in front of patients and colleagues. There is no shame in trying to be as accurate as possible, using the best decision models for complex health problems and offering up-to-date, guideline-based treatment. If AI drafts my notes and discharge summaries, I gain time to sit with a dying patient or a stressed family, which is worth more than paperwork. Refusing to use it on principle is like doing long calculations by hand because humans are supposed to be smart enough. Would you want your disease risk estimated from someone's memory, or with a validated calculator on their phone?
Of course, a tool is only as good as its user. AI output has to be verified, and patient data should only go into approved, privacy-compliant systems. But health systems and medical societies should encourage responsible adoption. One simple step is allowing medical AI tools to be reimbursed from CME funds. Systems should also explore AI integrated into the EMR, where early tools are showing promise.
Conclusion
Whether it is a CT, an echo, an MRI, or the latest AI model, these are tools that support physician decision-making, productivity, and patient safety. Used well, they free us to give patients what only humans can: interaction, reassurance, and the comfort of being cared for by an empathetic, compassionate doctor in a safe place. They may also reduce burnout.
So the art of medicine is not dying. History taking and the physical exam still have great value and no substitute. But we have more tools than ever, and refusing to use them in the service of better, more compassionate care sits uneasily with the oath we take such pride in.
Disclaimer: The views expressed here are my own and do not represent those of my employer or any institution I am affiliated with. This article is for general informational and educational purposes only. It is not medical advice and does not create a physician-patient relationship. Please consult a qualified healthcare professional about your own health.
More about who's writing this is on the About page. If this got you thinking, or you'd push back on any of it, I'd genuinely love to hear it: sharma.rujjwal [at] gmail [dot] com.
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