Making Rounds
For one month each year, two esteemed cardiac specialists at Mount Sinai Hospital make rounds each morning at the hospital's cardiac unit to demonstrate the vanishing art of bedside diagnosis to young doctors. These two specialists -- Dr. Valentin Fuster, Mount Sinai's Physician in Chief, and Herschel Sklaroff, a clinical professor of cardiology at the hospital -- are the focus of this documentary by Muffie Meyer.
The two accomplished physicians were trained "old school," as they have it, and they astonish the residents with their ability to diagnose not just the patients' ailments, but also discern what medications they are on, all through careful observation and perceptive questioning. The key? Listening to the people in their care, rather than adopting a clinical distance that reduces individuals to data on charts.
Their expertise is roundly demonstrated in their interactions with a handful of hospital patients suffering from an array of cardiac problems. Some need drastic medical intervention, such as heart transplants; for others, it's a matter of learning how to manage larger health issues such as diabetes, which can have a bearing on cardiac health. Some can be treated; others can only be made comfortable as their incurable conditions take their course.
Again and again, though, the film demonstrates the importance, and the curative effects, of direct personal contact between physician and patient. If bedside diagnoses is a dying skill, it threatens to take truly attentive care along with it. As one of the doctors laments, "Today, you don't get paid for thinking. You get paid for tests.... The art of medicine is you go to the patient's bedside. You sit down and talk."
Or, as the other doctor puts it, "Technology is available, but your head should also be available."
The film doesn't exactly condemn the medical system as it currently operates, but it does make some sobering observations -- the cost of a single medical procedure, for instance, versus the cost of ongoing preventative care. (Guess which one can be had for bargain basement prices?) Then there's the shocking statistic that indicates a staggering frequency of misdiagnosis -- between 10 and 20%.
Involving and illuminating, this is one of those films that ought to be part of the greater discussion, and factor into how policy decisions are designed and implemented.
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