When we trained at medical school we were taught to approach each patient on his or her own merits. We were taught to take a history: ask questions about past medical problems, drugs and present complaints; to do a physical examination and make a management plan including those tests that allowed us to narrow the range of possible diagnoses. Treatment was the next option. After we learned to do all this, we were awarded the title of doctor – professionally trained, licensed and regulated to carry out the procedures described. This model of actions which has a long history is called clinical medicine. But what impact has Covid-19 had on this tried and tested way of doing things?
In the last 30 years, clinical medicine has had two important evolutions. The first was the recognition of the primacy of the patient in all our actions. Physicians then become benign agents between the patients and the ‘system’ giving the best advice possible, reducing uncertainties, and directing action when needed on the basis of interpretation of the complex set of circumstances of each patient. The second is the advent of evidence-based medicine (EBM), or the recognition that any course of action needs to be based on the best available up to date scientific evidence. When there is uncertainty this needs to be communicated to the patient.
Patient-centricity and EBM became swiftly incorporated into clinical medicine. Communication, partnership and teamwork and ‘Maintaining Trust’ became essential components of Good Medical Practice – the essential guidance that describes what it means to be a good doctor. Effectively interacting with others and ensuring that all concerns are heard and above all ensuring the care of our patients is our first concern. The advent of the Covid-19 pandemic, however, has seen a retreat of clinical medicine, patient centricity and EBM.
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