Clinical paradigms revisited.

Abstract

Despite astounding advances in scientific knowledge and technological capabilities, modern medicine is not free of significant problems. A persistent high rate of diagnostic errors, the prevalence of medical (iatrogenic) harm and the growing demand for complementary and alternative medicine indicate an urgent need for improvement. An important step is a return to three quintessential clinical paradigms that have become neglected with the advent of high-technology medicine: the need to emphasise prevention and early, presymptomatic diagnosis; the crucial role in decision making of skillful history taking and examination, backed by evidence; and enhanced attention to patient autonomy and emotional factors. Possible reasons for the current neglect of these Altneuparadigms ("old-new" paradigms) are considered, and techniques for restoring their primacy in medicine are discussed.