new_n_lost
Politically InCorrect
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Physicians are some of the most hypereducated professionals around, with eight years of higher education, followed by three to 10 years of residency and subspecialty training over thousands of hours. They also must pass some of the most exacting and complex licensing exams ever written, including at least four separate tests requiring weeks of dedicated study to achieve board certification. And yet, according to studies like Mangione-Smith's, most doctors in practice don't pass muster in administering optimal care for elementary conditions like infant diarrhea.
To be paid at the appropriate level, physicians must exhaustively document all sorts of irrelevant diagnostic data—such as a rectal exam in toddlers seen for a comprehensive asthma evaluation—rather than the rationale for the treatment they prescribe
Consider the college prerequisites to attend medical school (for example, physics and organic chemistry) and the morass of molecular biology, anatomy lessons, and pharmacology that follows and must be committed to memory. Of course, a general foundation is important. However, the sheer abundance crowds out an important—in fact, the only—skill that matters in treating a patient: how to critically appraise published clinical trials. Few doctors ever read them. In effect, medicine has become a priesthood of practitioners who never review or learn to interpret the Bible to minister to their flock; they instead rely on secondhand wisdom. Or, worse, on Google.
The most widely used service is UpToDate.com, a private-equity-backed, subscription-only Web site that, according to some research, is accessed by half the clinicians at hospitals affiliated with Harvard Medical School at least five times a week. Eighty-seven percent of U.S. teaching hospitals subscribe to it. On the site are thousands of recipelike entries on everything from toddler ear infections to drug therapy for heart failure. UpToDate.com has become the cookbook for medical treatment. No professional primary-care medical association, like the American Medical Association or American Academy of Pediatrics, has created anything like it.
And while the overall quality of information is quite good, the treatment guidelines tend to favor medications over modifying behavior and lifestyle, are not vetted by any government or other professional association, rely a lot on the personal views of the one or two authors of each recipe, and rarely include any cost-benefit analysis. Fundamentally, by neglecting treatment, doctors have outsourced it to private contractors who don't answer to any authority. (This is why drug companies can launch misleading marketing campaigns without a unified voice arguing on the side of the data.)
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