The enormous amount of technology that doctors now must master has crowded out physical diagnosis, he said. But, he noted, "there is a giant chunk of diagnosis that still depends on what we see and detect" through observation and a physical exam.

For a surprising number of diseases, McGee added, diagnosis is based on observation and examination, not a test. Among them are Parkinson's disease, shingles, drug rashes and constrictive pericarditis.

These days, medical students often train on actors who are only pretending to have medical problems, notes Poonam Hosamani, a newly minted hospital-based internist who joined the Stanford team last year.

Hosamani said that she recently enlisted her husband, who has a bad knee, as a featured patient. Many students told her they had never seen a patient with a knee problem. "When we bring in patients with real pathologies, the students are very excited about that," she said. "We have to show them that this is worth their time and demonstrate how much information you can gain" through a good exam, which is not intended to replace technology but to guide its use.

Internist John Kugler, an assistant professor of medicine at Stanford, said that typically medical students learn diagnosis skills before they have seen patients. "They are taught where to put their hands, but these techniques are taught in isolation and there is little to no reinforcement," he said. 

W. Reid Thompson, a pediatric cardiologist at Hopkins, launched Murmurlab, a website containing the normal and abnormal heart sounds of more than 1,300 people, in part to curb unnecessary referrals for echocardiograms, which cost up to $900 apiece.

Heart murmurs in children, Thompson said, are common -- between 60 and 70 percent of children have them -- but only about 1 percent are problematic. Distinguishing "innocent" murmurs from serious ones, he said, is an essential skill for physicians, not just cardiologists. But studies have repeatedly found that many doctors do a poor job with auscultation, or listening to the heart and lungs with a stethoscope.

Despite doctors' reliance on a plethora of sophisticated tests, auscultation remains "a fundamental clinical skill," Thompson says. "Every day . . . I walk up to a patient and the first thing I do is listen" to the heart. "People walk around with a stethoscope not just because it looks good or is expected, but because there is information to be learned."

But Thompson said it is not yet clear whether Murmurlab has improved doctors' skills. Stanford officials say they are attempting to devise ways to measure the impact of their program as well.

Lots of data, little interaction 

In a recent essay, Arnold Relman, a former editor of the New England Journal of Medicine, described the months he spent last summer at Massachusetts General Hospital after he broke his neck in a near-fatal fall. "Doctors now spend more time with their computers than at the bedside," wrote Relman, an emeritus professor of medicine at Harvard. Reviewing records of his hospital stay, Relman "found only brief descriptions of how I felt and looked" but "copious reports of the data from tests and monitoring devices." Conversations with his doctors were "infrequent, brief and hardly ever reported."

McGee said that he once saw a nurse tell a resident that a patient had spiked a fever and watched as the young doctor frantically scrolled through the electronic medical record searching for a cause, instead of walking down the hall to the patient's room to discover the reason: an inflamed IV site.

"In most hospitals today, the average amount of time a busy intern spends with a patient is four minutes," said Brendan Reilly, who until recently was the executive vice chairman of medicine at New York-Presbyterian Hospital. No longer are tests ordered based on the results of a careful physical exam and history, Reilly said, but the "technological tests become the primary source of information on the patient. It's backward now," and the process is driving up health-care costs and subjecting patients to the risks posed by sometimes unnecessary, risky procedures.

"Doctors trained outside the U.S. are much better clinically than young American doctors," said Reilly, the author of "One Doctor," an unsparing 2013 account of his medical career. They are trained -- or forced by circumstance -- to rely less on technology and more on physical diagnosis skills. 

The Stanford Medicine 25 program reflects Verghese's medical training in Ethiopia in the 1980s. Doctors were required to hone their clinical skills because technology was largely nonexistent.

"In some ways," Reilly said, "what Verghese is doing is opening people's eyes and showing that medicine can be a lot of fun."

Reilly said he hopes the accountable care organizations that are part of the new health law - groups of doctors that band together with hospitals to improve the quality of care for patients and share in cost savings - might boost the effort to revive bedside medicine. "The current system is so ridiculous and inefficient and expensive that we're going to have to go back to doing some of the old stuff."

A Skill Set For Doctors

Some components of a physical exam are familiar, such as listening to the lungs and heart, and assessing blood pressure and pulse. But parts of the Stanford Medicine 25 -- a list of skills that the school considers important for doctors to know how to perform -- may be less familiar. Below are some of those beside tests:

• Feel lymph nodes and differentiate benign enlargement from possible maligancy.
• Evaluate patient's walk for signs of neurological or musculoskeletal impairment.
• Inspect the tongue for the presence of infection or underlying illness.
• Feel the thyroid gland and palpate the spleen to check for enlargement.
• Assess the liver, checking for tenderness and enlargement, and recognize signs of liver disease elsewhere in the body.
• Evaluate tremors and involuntary movements.
• Examine fingernails for signs of kidney, heart or lung disease or nicotine use.
• Check shoulders for range of motion.
• Evaluate knees for pain and movement.

The complete list is available on the Stanford School of Medicine website

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.