In an era of uncertainty, who decides?
We appear to be entering an era of uncertainty, where once again we realize that the practice of medicine is an art, not a science.
While doctors may carry scientific tomes in their heads and engineering marvels on and around their persons (although surprisingly few computers to date), the clinical practice of medicine is being rediscovered as an art, not a cookbook science. As new studies challenge the existing metrics evaluating risk through a black/ white approach dedicated to lowering intermediate clinical markers (see cholesterol for the otherwise low risk patient, glucose for Type 2 diabetics, BMI for the overweight, quantity of bloodborn “humors” to be released by lancet, etc)
Big lesson: Lower does not mean better
So, as we find out that cookbook medicine may actually be harmful in addition to being expensive, we have the same issue that is currently cracking the mortgage industry: evaluating and managing risk is hard and replacing underwriting with automation and customer service reps leads to problems when real judgment is required.
So where is that judgment required? Some docs, threatened by the emergence of retail clinics, believe it needs to be by a medical specialist in every encounter. John Wennberg and his group would say that its probably the opposite. And given the fundamental uncertainty, if you trust the experts in complex, hard to evaluate matters, which ones should you choose?
Today, it seems that the unknown biases of the “experts” who are the gatekeepers to the rest of the system unfairly impact the choices presented to individual consumers. For example, a rape victim going to a pharmacy for Plan B may be denied by the religious beliefs of the pharmacist. I wasn’t presented the choice of surgery for my blow-out fracture (with severe diplopia and an eye that moved as I sneezed) due to the beliefs of a particular department chairman. Its all too common to prescribe a polypharmacy prior to any serious attempt to counsel improvement in diet and exercise. Pregnant women often get told that they need to stay in bed for long periods due to spotting.
Since the “knowledge” of the experts often seems inadequate to give real statistics on the level of risk for individual situations, wouldn’t it seem better that we should know their biases prior to taking their advice? As a consumer-focused world evolves, the consumer knows which doc is a top 10% Lipitor prescriber as much as Pfizer does. Only then will the consumer be on equal ground and have the information to make their own health choices.
