> Despite often repeating the mantra “First, do no harm,” doctors have difficulty with doing less — even nothing. We find it hard to refrain from trying another drug, blood test, imaging study or surgery. It's disappointing that the conflict-of-interest is not better recognized. Asking a surgeon if you need surgery? Do you really expect a person under a pile of medical-school debt to give you an unbiased answer?
If the problem were the medical-school debt, I would expect junior physicians to be more worried about it than senior physicians, no?
I really wish people would quit treating doctors as unquestionable authorities on health. Rather, they should be treated as consultants - expertise for hire - who should be able to give good answers to most questions, but should expect to have to defend their recommendations, and can sometimes be wrong.
> Despite often repeating the mantra “First, do no harm,” doctors have difficulty with doing less — even nothing. We find it hard to refrain from trying another drug, blood test, imaging study or surgery. It's disappointing that the conflict-of-interest is not better recognized. Asking a surgeon if you need surgery? Do you really expect a person under a pile of medical-school debt to give you an unbiased answer?
Most medical doctors in the US aren't paid as a function of patients seen. Unless they're in a niche subset of medicine (cosmetic surgery) or have their own practice setup (hint: you won't find surgeons buried in school debt operating their own practice; the overhead is insane [staff, material goods, and oh god the insurance] would bankrupt a surgeon straight out of residency/fellowship), they're going to be debtors regardless of whether or not that blood test or drug is administered, or whether or not they send out for that radiology consult. It's almost certainly "when all you've been trained with is a hammer , ..." syndrome as others here have said
Maybe when the top doctors are away at meetings the sickest patients no longer get transferred to the tertiary center for care and are kept at the local hospitals.
I think this is an unlikely explanation, but you got an upvote from me for even suggesting an alternative explanation for the findings.
Thats the reason I don't like dentists who are also proprietors and have fewer patients due to the location of their clinics. Too much conflict of interest - there is no point for them to wait and see if a tooth can reinitialize, they'd rather take off healthy tissue to make a buck. I'd rather go to a established chain clinic where dentists are employees and they always have patients anyway because of the location (large popular mall).
I really wish people would quit treating doctors as unquestionable authorities on health. Rather, they should be treated as consultants - expertise for hire - who should be able to give good answers to most questions, but should expect to have to defend their recommendations, and can sometimes be wrong.
Medical doctors are like auto-mechanics or, to make a more HN-relatable comparison, software engineers trying to debug a program. Except there's a little more schooling, a lot more rigor with boards examinations, and you don't really have the full source-code available to debug. Just like in any profession, you're going to have crappy auto-mechanics who'll just pull up the ODB-II code and perform patch-work without rigorous root-cause analysis, or have engineers who'll also perform similar patch-work to get it "good enough", you'll have the same hacks who make it through medical school. I'm with you 100% in that they're consultants offering their opinion, but I'll take your analogy a step further and say that some consultants are 27 year old kids fresh out of Wharton who can put together a pretty PowerPoint deck, and some consultants genuinely know their field.
40% of people eating dark chocolate got hit by lightning. Come on people. No more statistics.
I find your complaint rather baffling: statistics is how we figure out what is going on in large populations when many variables are in play. How else would we advance medical science?
Yes, as the recent "reproducibility crisis" has shown us (http://blogs.discovermagazine.com/neuroskeptic/2015/11/10/re...), there is severe danger in playing with statistics, even mildly. But that does not mean we should stop using statistics altogether: it means we should come up with better protocols and procedures to prevent the biases we discover.
Very bad title: it implicitly equates "Good Doctors" with "famous doctors" rather than with "doctors whose actions benefit patients". The real point of the article is that one should ask questions and be personally involved in care decisions, rather than just taking the doctor's word. But the linkbait headline obfuscates that point.
The article uses "best" and "senior" as well, more often than "famous", and explains that the data refers to times when "the senior cardiologists were out of town" (anyone attending conventions, for example.) It's unlikely there are enough "famous" cardiologists alone to have accounted for "tens of thousands" of admissions. If so, the meaning of "famous" is downgraded to those who are sufficiently senior, rather than…
> The article uses "best" and "senior" as well, more often than "famous"
Yes, you're right, "famous" is too narrow, "senior" would be a better term.
Very bad title: it implicitly equates "Good Doctors" with "famous doctors" rather than with "doctors whose actions benefit patients". The real point of the article is that one should ask questions and be personally involved in care decisions, rather than just taking the doctor's word. But the linkbait headline obfuscates that point.
Hmm, I think I disagree. It was pretty obvious to me that when they used the term "good doctor" they meant better by some objective criteria that many people use as a proxy for "doctor whose actions benefit patients". If "good doctor" had meant "doctor whose actions benefit patients" it would be a contradiction that most would-be readers could dismiss.
> It was pretty obvious to me that when they used the term "good doctor" they meant better by some objective criteria that many people use as a proxy for "doctor whose actions benefit patients".
But those doctors aren't better by those objective criteria [1]; that's the whole point. Their patients do worse, on average, by objective criteria. So they aren't "good doctors" in the sense that patients care about. They are only "good doctors" if you equate "good doctors" with "senior doctors" or something like that (as gdulli pointed out upthread, "famous", the term I used in my OP in this thread, is too narrow)--something which does not include the objective criteria about actual patient outcomes.
[1] At least, that's what the article is claiming. As others in this subthread have pointed out, there is other data that should be looked at to see how valid the claim actually is.
Very bad title: it implicitly equates "Good Doctors" with "famous doctors" rather than with "doctors whose actions benefit patients". The real point of the article is that one should ask questions and be personally involved in care decisions, rather than just taking the doctor's word. But the linkbait headline obfuscates that point.
The authors suggest it is due to a reduced number of unnecessary treatments: >"Our results echo paradoxical findings documented during a labor strike by Israeli physicians in 2000, in which hundreds of thousands of outpatient visits and elective surgical procedures were cancelled, but by many accounts mortality rates dramatically fell during the year.27 Similar reports of decreased mortality during physician labor st…
> What they should have done is plot mortality by week so we can see if there is a sudden dip around the conference dates.
Agreed, this would be a better test of what they are claiming.