The medical profession today faces many problems. We march to bureaucratic drummers, we have lost our autonomy, our prestige has spiraled downward, and our professionalism is sagging.1, 2 But our woes don’t end there.
Lurking in the shadow of these ills is yet another medical malady, one for which we are solely responsible, and one that endangers the public we serve. It begins in medical school, where it almost never receives the attention it deserves. During residency training, it remains easy to spot, but efforts to spot it are not routine. And even when it becomes conspicuous, measures to correct it are often ignored, inadequate, or temporary at best.
I call this malady hyposkillia—deficiency of clinical skills. By definition, those afflicted are ill-equipped to render good patient care. Yet, residency training programs across the country are graduating a growing number of these “hyposkilliacs”— physicians who cannot take an adequate medical history, cannot perform a reliable physical examination, cannot critically assess the information they gather, cannot create a sound management plan, have little reasoning power, and communicate poorly. Moreover, they rarely spend enough time to know their patients “through and through.”3 And because they are quick to treat everybody, they learn nothing about the natural history of disease.