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I have a lot of social contact with physicians...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.

If I had to make a concession such as that before beginning my arguement, I'd probably rethink the validity of my arguement.

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.

Right, lemmie make sure I'm getting this. Demand is on the physician side, so no one goes to a doctor because they feel sick or to have a preventative checkup. Only there because the doctors want them there. Also, once people do get into the doctors office, they never pressure them for the newest treatments or for unnecessary procedures (for example, no parent has ever demanded antibioctics for his/her child when they were medically unnecessary).

Get a grip. Patients are the ones demanding medical services. Doctors aren't jockeying for position to force their services down their throat. Whether the doctor elects to use a new treatment or not is a function of patient insistence, professional judgement by the attending physician (which includes such factors as how up to date the doctor keeps his skills, how aggressive he is in integrating the latest technology into his practice, &c.).

The point I was trying to make was that since the employer picks up the tab for the majority of medical costs (in the form of all or some of insurance premiums) then the employee as consumer of medical services has only a nominal cost (often a copay) for expensive medical services. This is effectively a subsidy, and what you subsidize you get more of. Hence, people are using medical insurance for routine office visits. When was the last time you used your auto insurance for an oil change?

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.

So, if you're in the ER and dying of a puncture wound, you'd like a team of experts to consult with each other before any services are rendered? Or, as a parent whose child is dehydrated from some variant stomach flu that is going around, you're going to accept a few days wait while a few experts get together and do a peer review on the variant strain and then they'll get back with you?

Now, wrt your engineering analogy. First, the fact that you would compare engineering with medecine is very revealing about your understanding of medecine. Second, correct me if I'm wrong, but bridges are built to maximum specifications, that is, the maximum anticipatde load is determined in advance, and then established mathematical formulae will yield the proper design specifications (gross oversimplification, to be sure, but the point is that the maximum load which, in connection with known quantites, such as the strength of the design material, it's weight, &c. yield a predictable outcome).

With the various permutations of body types & conditions and injuries present a much more squishy predicament. It's presicely becuase comparitively so little is known about human body that major breakthroughs can occur. When was the last significant breakthrough in bridge building? Apples to oranges comparison amigo.

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.

Thanks for reinforcing your concession above that all you have to operate on is your opinion.

It is most certainly a problem of ego, and of training, and of a systemic defect in the physician's method of practicing.

As long as you're content to focus on opinion, I'll join you. Looking back over my life, I can think of only one physician I, my wife, or our children have been to who truly had ego problems. All the rest were either easily approchable or willing to take time to explain what they were doing and the alternatives. Now, I'm not saying my anecdotes are better than yours, but I'm contesting that your experience is universal.

Also, food for thought for you. I recall hearing a study that concluded doctors learn the equivalent of 2.5 languages in their training. I wonder if you're confusing the understandable frustration of someone who just knows a lot more than you do being questioned by someone who doesn't know as much and then his having to dumb down a highly technical explanation to a layperson.

Incidentally, if your wife is a nurse and that is her "particular" reasons for having insight, I'd discard that out of hand. We had nurses fighting our doctors over med doses (and a few other issues) the last time my wife was hospitalized. Once the nurse got off her "the doctor thinks he's G_d" tangent (which she was not hesitant about sharing with us) and listened to the docs explanation, she realized, to her horror, she was wrong.

You wife might not be a nurse, but some of your extreme positions from her "particular" experience sound a lot like our attending nurse.

Whether he is right, or he is wrong, he is seldom reviewed.

Right, which is why out of control lawsuits (which are clearly not a strong check or review </sarcasm>) have done a lot of damage to ER professionals (those most likely to have to make judgement calls of life and death) and obstetrical practitioners. Let me know when you make your trip back to reality and we can continue this conversation at that time.

Listen, doctors make mistakes all of the time. Do they make them with any more frequency than other professionals in their respective spheres. My gut tells me no, but the negative consequences of the bad exercises of judgement are far more visible than an accountant who blesses an erroneous cash flow statement. Combine this with the american system of litigants paying their own attorney fees and unscrupulus attorneys who are willing to gamble on the hopes of a large payout for a marginal (or worse) case, and I believe there is actually a strong bias built into the system for doctors to be very careful.

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.

Ah, the trial lawyer in shining armor. My hero.

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.

You've proven nothing. You initially attempted an inappropriate appeal to authority (argumentum ad vericundiam) by stating you had contacts in the profession and read their literature, and then proceded with your op-ed. You didn't cite anything but your own opinion, which is fine, but it doesn't prove anything (other than that your mind is made up).
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