Dear Editor,

The clinical method is the process or orderly sequence of actions that physicians have developed to generate their knowledge since the beginning of the scientific age. It is the scientific method applied to clinical practice, it is the order traveled to study and understand the health and disease process of a subject in all its social, biological, and psychological integrity ¹ .

In ancient times and for a long time, the clinical method was the only tool for doctors to be able to make an accurate diagnosis and treat their patients. However, over time, equipment, procedures, and techniques emerged and developed, which gave way to the emergence and improvement of the so-called “diagnostic tools” today.

Scientific advances have also led to a better knowledge of etiopathogenesis, the development of new therapies and the development of rehabilitation ² . Diagnostic means are part of the clinical method: they complement the diagnosis proposed by the doctor as a result of the application of the aforementioned method, help to make therapeutic decisions and to follow the evolution of different entities, can confirm the diagnosis of diseases in their early stages, and even reveal diseases with an asymptomatic course.

It is evident that technological scientific advances have contributed significantly to raising the quality of the diagnosis and treatment of almost all diseases. On the other hand, they have generated a problem worldwide and it is the crisis in which the clinical method is plunged due to the excessive use of diagnostic means as a result of growing technological development. What are the causes of this problem, what consequences does it entail, and what would be the ways to solve it?

Authors such as Moreno-Rodríguez ³ and Aparicio-Martínez ⁴ have called this phenomenon “the universal crisis of the clinical method”, where a series of factors are combined, including the inadequate use of scientific and technical advances and discoveries, advances in diagnostic means, and the decision of many health professionals to devote more and more time to care responsibilities, thus affecting their role as clinical teachers. It can be said that the abilities to observe and listen to the patient, to reason and interpret signs and symptoms, have been replaced by a more easy-going and mercantilist behavior, which, far from benefiting, harms the patient and the health system ⁵ .

There is a crisis in the clinical method that has worrying consequences for both developed and underdeveloped countries. This crisis revolves mainly around the following aspects: deterioration of the doctor-patient relationship, underestimation of the value of the interrogation and physical examination, and overvaluation of the role of technology ² . There is a coincidence that the vertiginous technological development has stimulated a mentality that leads medical professionals to carry out certain investigations not because they are necessary, but because they are possible ⁶ .

The irrational use of complementary diagnostic exams in medical practice implies a negative social impact of science and technology on medicine, not only because of the unnecessary submission of people to the procedure, the overuse of technological equipment, the excessive expenditure of material resources, and the work overload of the personnel that perform them, but also because of the technological diagnostic dependence of the doctor, and the detriment of the application of the clinical method. In the end, they consider for reflection the phrase of Bernard Lown: “the patient's blood is on its way to the laboratory before finishing talking to him and long before laying a hand on him” ⁷ .

This way of acting causes the abandonment of the clinical method, which is fundamental in medical care. In many countries, it even makes some doctors stop being true doctors to become indicators of examinations and tests to find the diagnosis. They are not physicians who use the proper method to diagnose the patient's condition through inquiry and reasoning. This behavior leads to fragmentation of medical care and loss of skills to conduct the questioning and physical examination, leading to negative results ² .

On the other hand, this crisis has penetrated even within many medical universities in which, perhaps, the teaching and application of the clinical method play a fundamental role in the study plans, but in the daily environment in which the study is developed, the reality regarding the use of the clinical method is different.

The educational training process of the health professional must be based on the learning of the clinical method since this constitutes its main tool to reach the diagnosis of diseases. The final result of its application should not reflect any contradiction between the advances of the scientific-technical revolution ^{5 , 7} .

Another key to curbing the excessive use of diagnostic means lies in justifying the need for each complementary test so that the application of the clinical method has to be resorted to. In addition, it is necessary to increase the knowledge of medical students about the importance of the clinical method and the advantages it offers, at the same time that it is rigorously taught and its application is witnessed as a daily and almost obligatory activity of the student’s training.

The flow in patient care should be firstly the application of the clinical method and then the completion of complementary exams, and not vice versa, since the use of technologies, far from raising the quality of patient care, causes increased stress on the patient, exposure of the patient to unnecessary risks or even the production of damage to the patient.

In the future, without a doubt, science will continue to create the most dissimilar technologies, which will surely have a positive impact in the field of medical sciences, but we advocate turning its application into one of the stages of the clinical method and we do not leave under any concept that the clinical method becomes a stage of its application.