By Diego Gutiérrez Mejía
Medical Education Specialist
“HE WHO DOESN’T PUT THE FINGER IN, PUTS HIS PAW”, a famous phrase pronounced by many of our teachers during their time as a medical student at the University of Caldas, an alma mater from which I graduated more than 40 years ago, but in my research in other schools have also been used.
I decided to write this dissertation as a result of an article that appeared a few days ago in the written press, where a medical professional is denigrated and honored by accusing him of being a rapist, without having been investigated, tried and convicted by a competent authority, after having listened to it in a free version and presented the pertinent arguments that give rise to declaring him guilty or innocent. I want to clarify that I am not defending anyone, but that this situation became a daily bread and we see news where many health professionals are involved due to their different actions in the assessment and conduct taken in front of their patients.
I start with the old saying of yore, as a trainer I was and will continue to be one of the different promotions of doctors for more than 25 years, since times have changed both the teaching and the assessment of patients in the medical profession, but despite Of the great advances in technology that have helped us to elucidate the pathologies and make individual decisions in favor of the health of the patients, the medical history continues to be the fundamental pillar to reach a more precise diagnosis.
In times of long ago, of pleasant remembrance, learning began by knowing the morphology and physiology of the human body from a theoretical point of view and after about three years, the student had to get in touch with the patient. I return and repeat, that the pillar of learning was the preparation of a good medical history that included an interrogation or anamnesis recording the reason for her ailment and the important medical and family history, which in the case of the female gender had to go through questions very intimate relationships related to your menstrual cycle, fertility, and sex life. Then, the physical examination was carried out, which consisted of the inspection or visualization of the patient in its entirety, the percussion that is knocking especially in areas where there is gas (chest, abdomen), palpation or manual examination on the different areas and finally auscultation with the stethoscope, to finally approach a clinical diagnosis. Much emphasis was placed on the visual assessment and sniffing of many secretions such as vomit, fecal stools, vaginal fluids, urine, which could guide the doctor in the clarification of the pathology to be studied. If we considered it necessary, paraclinical tests such as laboratory tests or diagnostic images were requested, but this was more secondary, since medical criteria were very important. There was a true doctor-patient relationship supported by ethical concepts and responsibility, almost that said professional became one more member of a family circle. This was inherited from European medicine.
But times were changing and many concepts enshrined in the classic Hippocratic Oath have been abolished by the enactment of laws that often conflict with the conscience of physicians, which fortunately they can wield an Objection in order not to be forced to comply with them.
Technology is being refined every day, but it cannot and should not displace the good clinical assessment of the patient, which is why they are called diagnostic aids.
From the Constitution of 91 in our country, the health and education laws were modified, for many for the better and for others for the worse, since the role can handle everything and despite the fact that the philosophy explained in it reaches almost perfection , The problem has been the application that is often permeated by petty, economic and political interests, where corruption walks with the consent of the control entities that do little or nothing to correct it.
The doctor-patient relationship that was so important became a machine (computer) -user, starting with the change in the nomination that was made to the patient, the time that health insurers allocate to the doctor to carry out the care is minimal not to say ridiculous (15-20 minutes), of course the clinical examination is deficient and many times the patient is in front of a professional who hears and speaks little, many do not evaluate patients but tests to define a behavior that if they could have been Complementing would diminish the failures in the results; It’s not your fault, it’s the system.
With the current legislation that is often approved on the run, that is, with a clean desk, it gives the feeling that there were no medical professionals on the congress premises who seem to have forgotten what their teachers taught them or were absorbed by politics and therefore standards are issued out of context.
The human being is a machine that is deteriorating and needs maintenance and the ideal is to carry out a comprehensive examination because there are pathologies that can be shared in the different systems that compose it, but doctors have already become fearful and with good reason, when they have to ask questions related to the initiation of sexual life, number of partners, frequency of sexual intercourse, pain (dyspareunia) during intercourse, type of sexual intercourse, use of erotic items, whether the genital area is well known and whether its The answer is negative that they do not hesitate to use a mirror, how is the cleaning of the anogenital area, which are basic to assess pathologies such as pain producers, risk factors for the appearance of cancer, infertility studies, narrowing of the intercourse channel as sequelae of a radiotherapy etc, because they will classify him as a satyr, lustful, abusive, degenerate and in the worst of cases a sexual abuser. To avoid prejudices that lead to think that a professional is viewed as lewd or morbid, it is permissible for minors, the elderly, the disabled and women to always be accompanied by an adult, unless the latter reject said accompaniment, as there is intimate things that in the interrogation they want only their treating doctor to know.
If we look at history in the eighteenth and nineteenth centuries, high court doctors examined patients by entering under the crinolines of the ladies where no one was looking to assess and make a diagnosis, and this was not looked at badly, they have been in our midst, upbringing and religious concepts have given nudity the name of sinful, because in other cultures this performance does not scandalize anyone.
To finish, I will return and I insist, you have to do a good promotion and prevention with the patients, guiding them to look at and touch all areas of the body without fear, including the intimate parts, forgetting about religious beliefs, teach them hygiene measures, use of elements mechanics when they are required to solve serious problems, since we can detect early signs that guide the doctor to make a proper diagnosis and treatment, and of course my colleagues who do not disdain a good clinical examination despite the circumstances that surround us and They cause us fear because, above all else, ethics and respect for the patient prevail, which must be mutual, that is, there is trust between the two, so that the doctor-patient relationship continues to be the reason for being of this beautiful profession.