A New England Journal of Medicine article by a Stanford physician urges medical schools against letting technology take the place of bedside skills.

Abraham Verghese, MD, doesn't blame technology for this trend. Instead, he turns his attention toward medical education and educators like himself in saying the "chart-as-surrogate-for-the-patient" approach to medical care is no replacement for the skilled, hands-on physical exam.

He says the advent of computerized medical records and easy availability of diagnostic tests has led to physicians getting to meet the "iPatient" - the virtual construct of a patient based on all the lab tests and imaging - even before they meet the real live human version waiting nearby in a hospital bed.

"The iPatient's blood counts and emanations are tracked and trended like a Dow Jones Index. ... The real patients keep the beds warm and ensure that the folders bearing their names stay alive on the computer," said Verghese.

He says there is a new push at Stanford to emphasize and improve bedside examination skills in students and residents in internal medicine, and calls for a similar national effort at all medical schools.

Verghese says doctors spend an "astonishing among of time in front of the monitor" charting in the electronic medical record, moving patients through the system, examining tests results. And medical students learn through example.

"In short, bedside skills have plummeted in inverse proportion to the available technology," he said.

"I truly believe that good bedside skills make residents more efficient," Verghese said. Doctors who rely on hands-on skills tend to order tests more judiciously, reducing the number of unnecessary and expensive trips to the radiology department.