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Subject:  Re: Stimulation and The Lack Thereof Date:  8/14/2004  9:45 PM
Author:  jiml8 Number:  8089 of 10592

Are you proposing a state funded solution?

Nope. But we have to do something.

A strongly worded assertion without a fig of evidence.

I have a lot of social contact with physicians. There are some in my family, and for particular reasons my wife knows a lot of them. So I talk to them a lot, and I talk to them about what they do and how they do it. I also watch the news and read certain medical journals.

I have, over a period of years, based on discussions and observations, formed some definite opinions about what they do that is right, and what they do that is wrong.

Insurance rates rise because of increased demand for the latest and greatest treatment (which are, hélas, expensive)

This demand is seldom driven by the patient, who very often has no clue at all. Much of this demand is from the doctors themselves who have been steered by the marketers who sell the machines and technology. This is not to condemn the "latest and greatest" in a blanket sense, of course, but all too often the latest technique is not the best technique, and costs far, far more than the "traditional technique" while providing only a marginal benefit.

It comes down to doctors not being cost sensitive and often not employing common sense, or more often being afraid to employ common sense because of fear of the lawyers. The system is badly broken, and the place to start is with the doctors.

let's not try to lay that at the feet of the canard of "giant egos" of physicians.

Much of the problem belongs there. Physicians for the most part try to do their best, but they often forget that they are fallible. Their institutional systems are such that there is very little oversight of individual doctors, and almost no no fault peer review of a doctor's work.

Consider, for instance, the case of the bridge designer. He is a highly skilled professional, who designs large and expensive structures to which many people will daily entrust their lives. He works continually under the expectation that his design work will be reviewed, and criticized, and he will often have to make changes to accommodate the reviewers.

In this fashion, bridges get built that meet their design criteria, those criteria are sensible, and it is quite rare for a bridge to fall down.

Similar conditions apply to the entire engineering profession, the software engineering profession, and the scientific community. Peer review keeps everyone sharp and allows multiple viewpoints to be brought to bear, and incidentally is inexorable about weeding out the incompetent.

Compare this to the general way a physician does business. If, for instance, something extremely unusual comes up (separating conjoined twins, for instance) he will go through a design process mapping out how to do the job, with review, input, and coordination from other physicians.

But this is the exception rather than the rule; usually he is on his own, makes his own decisions and his own calls, and patients live or die by whether or not he is right. His professional judgement is no better and no worse than the professional judgement of an engineer or scientist in that individual's area of competence; why, then, is it that the engineer and scientist are trained to expect review while the physician isn't? Very simple. This society practically deifies physicians, and they themselves buy into it. It is most certainly a problem of ego, and of training, and of a systemic defect in the physician's method of practicing.

Whether he is right, or he is wrong, he is seldom reviewed. That he was wrong often never comes to light because his profession shelters him from such review and from "attacks" by outsiders. This trait of the medical community is where the lawyers find their easiest point of attack; they say (with more than a bit of justice) that it is only THEY who are shining the light on the medical community and holding them accountable for their mistakes.

The medical system in this nation is badly broken. The doctors are at the heart of it, and much of the problem is a problem of ego. Clearly the doctors are not the only problem, but I would insist that they are the most important problem - after all, it is THEIR system. Pull on that string, and most of the rest of the problems will unravel.
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