Pearls and pitfalls in patient care: need to revive traditional clinical values

Medicine has achieved phenomenal progress in recent years, yet there is ample evidence of dysfunction, reflected in persistently high rates of misdiagnosis, frequent iatrogenic illness, the popularity of 'alternative' medicine, and rising healthcare costs. An urgent need for a change is indicated. True adherence to basic clinical and personal values may avoid significant pitfalls in patient care. These include the immense value of a really careful history and physical examination; the wealth of information that can be obtained through patient's families, physicians, past records, and a search of electronic databases for the best evidence; restraint in management decisions; making the most of simple preventive measures and effective nonpharmacological interventions; appropriate "bed-to-door" intervals; a more personal care of the patient as a unique person, paying more attention to emotional factors that affect medical illness; constructive management of medical errors; and humility. The great potential of the many recent advances in medicine may be more fully realized if we accept that new capabilities should complement, not replace, old values and skills, which still make the essential foundation for medical decision making and patient care.