Subjective Measures and Clinical Decision Making

In the keynote address of this issue of Physical Therapy, Magistro mentioned the fear that medical care is becoming increasingly dehumanized. This unfortunate trend is most likely the result of many influences, some of which have been described previously. Feinstein sees an inordinate dependence on paraclinical methods (eg, anatomical, microbiological, electrophysiological) at the expense of what he calls distinctively clinical phenomena to be at least partially causing this dehumanizing trend.1 The distinctively clinical phenomena include type and severity of symptoms, rate of progression of illness, functional capacity, and “other aspects of the physical activities, joys and sorrows of daily life.” These “soft” data are usually lowly regarded and even intentionally repudiated among researchers and clinicians. This leads to little regard for the patient's description of his or her illness when making clinical decisions. Rather than ignore or deliberately reject these phenomena, Feinstein promotes their quantification.