Stanford 25 teaches bedside exam skills, focuses on human relations between doctor, patient

Sept. 5, 2019, 7:38 p.m.

In the past few decades, there has been much money and research invested into hospital automation, robotic-assisted surgeries and the use of artificial intelligence to optimize physician tasks. There are multiple questions being explored: Does computer automation replace the physician’s clinical or physical exam? Could physical diagnoses, aided with technology, improve clinical exams leading to better and more effective outcomes? Do automation and advanced technology benefit the care provider, the patient, both or neither?

Against this backdrop, Stanford Medicine 25 (Stanford 25) is an initiative that stresses the importance of interpersonal relations between doctor and patient, teaching doctors bedside physical examination skills that facilitate improved clinical diagnoses. 

“The initiative is to essentially make the doctor better at the bedside [examination] because we want them to feel more confident at the bedside and more capable at doing a clinical exam,” said clinical associate professor Errol Ozdalga, the company director of Stanford 25. 

It may come as a surprise that physical examination skills do not tend to be emphasized in physicians’ traditional medical curriculum. Patients tend to be the most anxious and apprehensive, but physicians are human as well and may experience similar anxiousness. Conversation between humans builds trust and creates a connection between the physician and the patient in a way that cannot be replicated through conversation with a machine, according to Ozdalga.

“To teach the physical exam skills with that bigger goal in mind of being by the bedside … present and connected … it’s kind of our way of saying, you know, a good doctor is not only caring and wonderful and supportive but also capable of doing the bedside exam and it kind of goes hand-in-hand with that patient-doctor connection,” Ozdalga said.

Still, he stressed that Stanford 25 is not inherently against technology used for physical diagnoses.

“Technology personally and as part of the initiative is used as an advantage and in many ways is the future, enhancing the physical examination … something that I rely on almost regularly,” Ozdalga said.

Stanford’s campus is not accessible to everyone, so Ozdalga and others in Stanford 25 have turned to technology as a means of spreading their knowledge to physicians around the world. Ozdalga said the Stanford 25 website “has gotten over 10 million page views since it was launched” and that, “in the last year, it was the most visited website at Stanford School of Medicine, other than Stanford’s news site.” He added that the Stanford 25 Youtube channel “has also seen pretty good success.”

“Resources on the Stanford Medicine 25 program from Day 1 are available [free] on our website, and there are no restrictions,” Ozdalga said. 

Ozdalga also travels the world to impart his know-how to other physicians. 

Though recent years have hosted great advancements in technology, there have been reports on overuse and borderline misuse of these capabilities. The fact remains, however, that the pace of medical innovation continues to increase. The deployment of new technologies in surgery creates many ethical challenges including how to determine the safety of the technology, what is the timing and process for deployment of a new technology, how are patients informed before undergoing a new procedure using a new technology, how are the outcomes of a new technology evaluated and how are the rights of individual patients and society at large balanced. 

Ozdalga spoke to the role of Stanford 25 against this backdrop of weariness about new technology. He noted that the program is part of the Presence initiative, which states on its website that it “champions the human experience in medicine.”

“One of [Presence’s] many goals is to maintain an ongoing dialogue specifically looking at AI and how it connects with medicine — to see how this plays a role in medicine going forward,” Ozdalga said. “As AI becomes more important in medicine, what are the positives and negatives around this?” 

Since AI and other technologies are changing medicine even as Stanford 25 goes on, Ozdalga said, “Whenever there is new technology to enhance how to do the physical exam, the program takes advantage of this by incorporating that into its teaching.” 

“In fact, the use of these technologies makes teaching so much easier as it resonates well with the student population,” he added.

While technological improvements have made life easier for patients and caregivers alike, the fundamental question of whether patients feel more comfortable in receiving care remains a grey area.

The main goal of Stanford 25, according to Ozdalga, is to enable physicians to be better at the bedside and at connecting with patients. Tests are generally ordered before a physician meets with the patient, and diagnoses can be made without having a physical exam. Having that initial data with a proper physical exam helps the physician be more confident. 

Contact Clyde John at cjtniles ‘at’

Clyde was a high school intern for The Daily in summer 2019.

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