Can doctors think ?

Like everyone else, I have heard some sad stories about how doctors mis-diagnosed or mis-treated their patients, to the point that I was wondering can doctors think?
There was a commentary yesterday on NPR radio by Michael Millenson (a health care quality expert and visiting scholar at Northwestern University's Kellogg School of Management) on the US health care quality issues. He said currently getting treatment for any disease based on the medical evidence happens on average only about 55% of the time. In another words, 45% of times, patients' treatment decisions were not based on medical facts and logical reasoning; rather, they were based on -
Occupational blinders. "Radiation oncologists think prostate cancer should be treated with radiation, while urological surgeons favor surgery".
Incorrect communications. "The doctor thought a treatment had been considered, but it hadn't".
Human limitations. "The doctor thought he was doing what's best, but his memory of the medical literature was flawed".
I like to add another - sometime doctors' decisions were based on how to avoid potential law suits, rather than the best interests of patients.
According to Mr. Millenson, in US we waste 30% of health-care dollar "providing treatments we don't need, not providing treatments we do, and fixing preventable medical mistakes". That adds up to a $700 billion every year.

1 comment:

Jim said...

I agree this is an interesting list. I would also suggest the "system" is inefficient and discourages doctor-patient interaction.

I visit the doctor infrequently, but when I do go, it seems I'm repeatedly asked similar information. I understand the check-in wants my birth date to verify there aren't multiple people named me, but beyond that, it seems silly to have to repeat it for the nurse and again to the doctor. A birth date is not something that changes. (I suspect the real reason is there are multiple, incompatible database involved.)

I've observed that the nurse's primary role seems to filter through the information, minimizing the doctor's actual time with the patient is minimized. He'll take blood pressure, measure my height (another non-malleable parameter), etc, then gather basic description of symptoms. I can hear the ruffling of the first page of the chart just before the doctor walks in. On rare occasions, such as a biannual physical, they'll look through the longer file history.

Also interesting is the frequency at which some useful nugget of information comes up in the minute after the doctor leaves. I've heard this referred to as the "doorknob effect," though I'm sure there's another, more common name. The theory is one's so rushed during the actual "appointment," that details are skipped. Some doctors will pause as they're about to walk out, waiting for the "Oh, by the way..."