Eminence, common sense, and evidence: a comment to the Andreas Grüntzig lecture 2015.

Abstract

In the old days, the Regius professors, white haired, distinguished and wise, rounded majestestetically with their fellows and staff.1 Patients were presented and examined, and the eminent doctor reached final decisions. What he felt was standard, what he heard was diagnostic—in short: eminence-based medicine ruled. And without any doubt, eminent physicians had excellent clinical skills and great experience. They knew what they were doing, but their diagnoses were primarily based on visual observation and clinical examination—and thus not rarely false. Then, modern diagnostic tools were introduced. First, X-rays discovered by Wilhelm Rontgen (1845–1923) in 1895 allowed a glimpse to the heart, then after the Second World War ultrasound, and finally nuclear scans. CT and MRI provided better and better insight into the body. Even Regius professors had to learn that they might be wrong: the liver looked larger with ultrasound than clinically expected, the heart murmur was not necessarily confirmed by echocardiography, and the suspected influenza proved to be a bacterial infection upon laboratory examination. The eye, hands, and ears of clinical examination were out ruled more and more by technical developments and objective measures. Similarly, predictions were sometimes right, but often wrong: some patients lived longer than anticipated, while others died suddenly after an uneventful examination. Indeed, risk factors were completely neglected; when Franklin D. Roosevelt died unexpectedly of a cerebral haemorrhage, his personal physician Admiral Ross McIntyre said ‘ Came out of blue sky !’ The fact that his blood pressure had steadily risen during his presidency and had reached exorbitant levels of 310/190 mmHg, had not disturbed the prominent …