To listen properly—and really focus on what is being said—takes time. In modern medical practice that is a commodity which is always in short supply. Many practices now place time constraints on providers and allocate a fixed amount of time for each patient visit. Listening gets rationed. This violates the core principles of good medical practice. It may seem reasonable at first, but on closer examination it makes little sense.
We are always reminded that time is money. So, let’s look at it that way. Which really costs more: a quick fifteen-minute visit followed by a stack of tests, or a half hour spent actually listening, examining, and maybe ordering fewer tests? Of course, the answer depends on whose side of the bill you are standing on. More tests may bring in more money for the organization, but someone still has to pay for them. And in the end, that someone is almost always the patient.
Sadly, I am no longer surprised when patients tell me they were “examined” without even getting undressed. I have experienced the same thing myself, so no, this is not some rare oversight. It is a failure of basic medical practice. A real examination means looking, feeling, listening, and observing how the patient responds. You cannot properly check reflexes, palpate an abdomen, or see what needs to be seen when the patient stays fully dressed. This should be obvious. The fact that it often is not should worry all of us.
Meanwhile, far too many patients are being scanned and tested when the most important tool we have—the one no machine can yet truly replace—is still a good examination. We have pushed that aside, almost as if it no longer matters. The new mindset seems to be: skip the exam, order the test, and let the machine sort it out. Sometimes that works. But it is lazy medicine when it replaces thinking, listening, and examining, and it drives costs through the roof.