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5 Reasons Why Your Doctors Don’t Do Right By You

5 Reasons Why Your Doctors Don’t Do Right By You

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:

Five reasons why doctors don't follow clinical best practices

Even when they try to stay current with the evidence, it’s often difficult to do so. Nor are clinical guidelines always objective or without their own faults – as amply discussed in my book.

Of course, the key driver, as always, is money. As the lead author of the study in Health Affairs stated at the forum in which the study was presented:

“Fee for service payment is the real culprit in that it provides a potent incentive to adopt treatments that are well reimbursed,  regardless of the evidence.”

 The BMJ analysis goes on to quote him as saying…

 “Physicians and patients in the U.S,…have a pro-intervention bias ‘even when the marginal benefit of doing so is small’…This played out in cardiology with a tendency to open up even minor blockages (with cardiac stents) that were not clinically meaningful.”

Marginal Benefit or Patient Injury?

 Here’s where I go a step further. It’s not just that these interventions often have only a marginal benefit – they often have no benefit or even injure patients who don’t really need the intervention.

The stent example is a good case in point. Cardiac stent procedures often offer no advantage over more conservative – and less profitable – medication management. But a study in The New England Journal of Medicine I cite in MedSmart Patients (soon to be released) found that an estimated 5-30% of these invasive procedures can actually CAUSE heart attacks that often go unnoticed at the time.

Our cultural and medical preference for interventions – for “doing something” – sees only upside to doing so. Seldom is the downside, often substantial, acknowledged or respected for the potential harm it may cause.

Doctors were once taught to intervene cautiously and seldom – to “do a lot of nothing”. While this seems counter-intuitive in today’s culture, it’s actually today’s culture that’s often counter-intuitive.

The wisdom of medical caution is to allow the body the time it needs to heal itself to the maximum extent possible – aided by personal behavioral changes that help promote an anti-inflammatory diet and lifestyle.

This is generally most applicable to chronic conditions that have proven largely unresponsive to high-tech medical interventions.

The following 3-minute video discusses one such example – that of back pain, one of the leading causes of physician office visits and unnecessary medical imaging. The spinal fusion surgeries that often ensue may be the biggest medical rip-off in America, with rates varying twenty-fold in the highest use regions of the country compared to the lowest. If you or anyone you care about suffers with chronic back pain, spend a few minutes watching this video.

And even if you don’t, it’s worth watching as an example of how best practices are often ignored in ordinary medical practice. Which is why second medical opinions are now so essential before agreeing to any invasive medical procedure.

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17 Awesome Comments So Far

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  1. Saude
    November 7, 2013 at 7:22 pm #

    I think alot of the problem is the enormous political lobbying done by the pharmaceutical industry. This almost undoubtedly leads to a system that is biased toward what is best for them, not the patient.

    Yep, wrong financial incentives, in all parts of the system.

  2. Chloe Wallace
    May 24, 2013 at 4:15 am #

    Thank you for posting this. Statistics show that approximately 195,000 people are killed every year by medical errors in the US. This alone alarms me. More and more are filing malpractice suits because of various medical mistakes and I and not aware if the government is doing something progressive about it.

  3. Nikki Tan
    May 9, 2013 at 8:52 am #

    Thank you very much for sharing this very nice article. My husband is a doctor and I am a nurse. Every time I open up to him about some issues like “why some doctors don’t really assess first their patients before letting them go surgery, why do some doctors prescribe drugs that are very expensive instead of generics?” He just always say, some doctors are tired of working because some of them work for more that 24 hours. With this, I do believe that it is their obligation to treat patients and save lives. They should not give a reason that they are tired or what. As health practicioners, it is our obligation to help them in their health problem.

  4. Anne Lim
    May 3, 2013 at 5:46 am #

    This is such a great article. I really agree with you. I am a nurse and working in a public hospital. I also noticed some doctors are like that, working partially to save lives and also for money. Yes, we all work for money but we should also take into consideration that as health workers, it is our obligation and duty to save lives. If doctors really love your work, then they should do what is right. Assess first the condition of the patient before giving medicines or letting them undergo a surgery.

  5. Brigitte
    April 30, 2013 at 2:50 am #

    Medical standards should not be neglected since almost everyday we encounter medical mistake cases. We should strive to level up our healthcare to provide highest care that patients need.

  6. Chiro Concepts
    April 16, 2013 at 10:31 am #

    Because our health care programs are not reliable, it is wise to look for ways of intervention especially in cases where the pain becomes chronic.

  7. Paul Shepherd
    April 16, 2013 at 5:16 am #

    John, this post is an Eye Opener. I remember the time when my mom was admitted in a nursing home for a puss-filled boil. Even after knowing that my mom’s sugar level was high and her blood pressure was not apt for surgery, he performed it without informing any of us – only for money. One day after the operation, my mom’s condition got worse and the doctor discharged her and sent her home on her own. We admitted her to a bigger and better hospital were she got satisfying treatment. Really, it’s hard to imagine to what extent some doctors will go for money.

  8. Jackly
    April 10, 2013 at 10:07 pm #

    Thank you, John.Great post! I will share it.I agree with you we should pay more attention to our health.

  9. Eddy
    April 9, 2013 at 11:08 am #

    A few years back I had a car accident. The Doctors told me I had broken my neck and may never walk again. But here I am walking and talking. They got it so wrong.

  10. Dravis A.
    April 9, 2013 at 10:24 am #

    Hi,

    Agreed! Great Article! I agree on “Neglect with Treatment Risk”. Doctors today don’t look at the risks of treatment or surgery, sometimes doctors just care about the money. People should really open their eyes about hospitals like these.

    Thanks,
    Dravis A.

  11. Susan Jones
    April 1, 2013 at 4:52 am #

    Your mentioned points indeed make sense. An active body is important for health and long-term living purposes and I think that, by following the right health care suggestions, anyone can achieve that goal nicely. These 5 reasons not only make people aware of these health issues but also their need start improving their health by following natural ways rather waiting for doctors’ suggestions. Thanks.

  12. lee
    March 18, 2013 at 12:37 pm #

    Hi

    These are really sound points. Over here in the UK, though, you have to add on…over-stretched resources, too few doctors, too many people. Just getting an appointment can be a nightmare. I am sure they hope you will be better before they see you so you will cancel.

    Great points. Thanks. Lee

  13. KeithRobinson
    March 13, 2013 at 8:22 pm #

    Your post is very sensible. I specifically agree it was mentioned how older doctors would most likely treat you. No offense to our old doctors but this is true in many cases.

  14. James Conner
    March 12, 2013 at 4:24 am #

    Nice post. We really have to exert more effort in making our health care better. We have to be conscious enough and aim for positive changes.

  15. Ohio Allergy
    March 11, 2013 at 1:00 am #

    This is a great post! Thanks for sharing. Health problems are quite increasing alarmingly nowadays. We need to care for our health more than anything else.

  16. Sara Biker
    March 9, 2013 at 8:35 am #

    Thank you, John. That’s a very useful post. I agree with you – health problems becomes worse with time & Most health organizations don’t really care. Thanks again for pointing this out.

  17. Dana Lorton
    December 25, 2012 at 3:06 pm #

    Thanks for the great info!

    You hit the head on the nail with these 5 reasons and your #1, wrong financial incentives is 100% correct! Who wants to treat a patient then only get pain like 5% of what they bill?

    Our healthcare system is broke and we patients who really need care are the ones who suffer. Enough already, something needs to be done!

    Thanks again for the info and for letting me vent…I feel better now.

    Regards,
    Dana

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