Whatever Happened to the Patient?

Lawrence Altman had an article yesterday in www.nytimes.com on the sad evolution of grand rounds. I feel light years away from Grand Rounds here in remote Guatemala, but this article dug up some buried frustration with academic medicine leftover from my days in Northern Manhattan.

Altman explains that patients used to be the centerpiece of grand rounds. A junior clinician presented the patient´s case to a master clinician. The master clinician taught the audience how to talk to the patient, examine the patient, and synthesize information to formulate a diagnosis.

These days Grand Rounds are about anything but the patient: basic science, clinical research, epidemiology, ethics, imaging, new and improved lab tests, health policy, financing, "the IIbIIIa Receptor, Yet Another Update," etc. etc.

Altman could have argued that Grand Rounds is just another example of the loss of patient-centered medicine. Somehow patients have virtually disappeared from the academic medical center. There are groins in the cath lab and liver biopsies in the pathology fridge, but an entire patient is nowhere to be found. Maybe they got lost amongst the grant applications, in the labs, or under the piles of insurance paperwork.