The Centers for Medicare and Medicaid Services have provided incentives for modernization to improve health care quality and efficiency. These include the development of an electronic medical record (EMR). Some federal organizations such as the Department of Veterans Affairs have implemented and improved on the EMR concept over the past decade. With this promotion of computerized medicine, several issues have emerged that may challenge the delivery of optimal medical care in a cost-effective manner. The time spent in direct contact with the patient may be reduced with more time dedicated to data entry. This limited contact with the patient may also result in a less detailed history and physical examination. Deficiencies in physical diagnosis skills in physicians in training were noted by Mangione in 1995. Many experienced clinicians believe additional attrition in the teaching of these skills has occurred since then. The de-emphasis of clinical training is perhaps beginning to emerge and prove costly. For example, indiscriminate ordering of MRI tests for back pain can result in such a backlog that reporting by radiologists may be delayed. More importantly, this delay may impact expeditious treatment for serious lesions. Additional education to healthcare providers emphasizing the key role of a good history and physical examination may be needed. This education will hopefully reduce the need for indiscriminate radiologic testing. The ready access to expensive radiology testing continues to provide a siren call to some clinicians. For instance, ordering parathyroid scans for primary hyper-parathyroidism appears reasonable, unless the patient is unwilling or unable to have surgery. Surely, it is better to inculcate these precepts early in one's career, preferably as a medical student.
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