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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.

you right about most of what you say, but there is a lot of peer-review in the system if you know where to look. insurance companies have physicians review things, there are morbidity and mortality conferences at most hospitals (although much of this is in retrospect), and tumor boards where new cases are discussed.

The problem with more peer review that will make it difficult to implement is who will do it? Physicians who already work 10-12 hour days (plus being on call many or most nights and many weekends)? I do stem cell transplantation, and few cities have more than 3 or 4 docs in this field - who is going to peer review our work? someone outside of our specialty?... do we do it over the internet as a videoconference and just sacrifice dinner, or make the 2pm patient wait an extra hour?

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

I don't feel that the medical system is "MY" system, as you suggest. And I doubt any of our nurses would say that I have an ego problem. Patients email me at 10pm some nights and often get an answer the same night. I can't bill for that advice, and am probably taking on a medical liability by providing that kind of service. is that a part of the problem?

Like a lot of things in life, it's easy to criticize when you don't have to be the one to come with or implement the solution.

email me if you'd like to discuss further, and i'll try to keep me ago from getting in the way.

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