This post isn’t going into the detail covered in Our Healthcare Sucks about “Why Doctors Do the Things They Do”.
Instead, this is about why they don’t do that which the clinical evidence of “best practices” demonstrates they should do. Doctors are notoriously slow in changing their practice behaviors. Most practice as they were trained.
If they’re older, they’re more likely to practice as they were trained decades ago. Younger doctors have been shown to practice more aggressively and cost more because of their training that favors high-tech medical interventions when low-tech, high-touch approaches may be better (especially for chronic disease conditions). A recent study showed that doctors with less than ten years experience in clinical practice had per patient costs about 50% higher than those with ten years or more experience.
This doesn’t mean they’re practicing better medicine. Younger doctors also show greater disdain for their obese patients – as discussed here in a recent blog post – which is ignorant, ill-advised and unprofessional.
“The Best Healthcare in the World”?
I discuss in Our Healthcare Sucks how the National Committee for Quality Assurance has found that diabetics in America receive recommended screening and monitoring services only 25% of the time – along with other data documenting the dismal state of American healthcare.
For all those who beat their chests about America having “the best healthcare in the world”, do they really think that 25% of recommended quality measures, or clinical best practices, is anything to brag about?
It’s data like these that led me to the title for the book – and for this website. There’s no other rational conclusion, unfortunately.
“Stick Your Best Practices”
So why don’t our doctors readily adopt medical best practices recommended by their peers, as generally occurs in other professions?
A recent article in the journal Health Affairs proposed five reasons that doctors are so slow to adopt scientific evidence in their medical practices. The following diagram illustrates these five reasons: