Does your doctor suck? Do you suck as a doctor? How do you know?
Well, the truth of the matter is it is simply a matter of opinion. I have been called “a brilliant doctor”, “singularly gifted”, “inspirational”, “hardcore”,”stupid”, “a menace to patients”, “cold” “heartless” and “asshole” and a few other good and bad adjectives.
So how do I go about deciding if I am a freedom fighter or a terrorist? (aka: which side am I really on?)
How do you decide if your doctor is good or bad? An important question, because it is your health and the health of your loved ones if you are wrong that is at stake.
There are really only 2 types of medicine. One is individualized care and the other is care by the numbers. I refer to this as “McMedicine” because it is no different than going to McDonalds and ordering a value meal off of the menu.
There is a lot to be said for McDonald’s way of doing things. They have analyzed every aspect of their operations, and can deliver a consistent product, everywhere they operate in the world. Their food is roughly the same price. It always tastes like shit no matter which country you are in. But if you are feeling like 2 all “beef” (we won’t quibble about the definition of “beef” here) patties, special sauce, lettuce, cheese, pickles, onions, on a sesame seed bun, you have only to order a #1 value meal and your culinary cravings, or the lesser of all evils that you must eat, shall be met.
So too has modern medicine attempted to replicate this consistency. Unfortunately, there is only one thing stopping success…Patients… If you work in healthcare, you know from your very first biology class in high school, everybody is different. Not in the sociological or cultural sense so much, but physically. We use words like human locus antigens, DNA, cell surface receptors, blood groups, and more to describe these differences. From biology, through molecular biology, biochemistry, physiology, and pathophysiology, we learn that every person is different for years.
From the patient point of view, we have all experienced side effects of medications, foods that we don’t tolerate well. Different preferred climates, perhaps an itchy cast, or ugly scar.
We know people are different. But some (“I’ll be generous) doctors, insist on treating everyone the same! Why?
Well, one school of thought is, if we quantitatively analyze all manner of medicine, we will come up with the treatments that work for the most people the most often. Nobody is fool enough to think there is going to be a treatment that works for everybody all the time. Unfortunately, “the most” and “most often” rarely hits 30%. Which means it will not work 70% of the time. But since it is the “most” there will be a clinical guideline and your healthcare provider will try this first. Let’s call it a #1 value meal. You know exactly what you are getting, and it will be consistent no matter what provider you go to if they are practicing McMedicine.
In the USA and moving to the British and Commonwealth countries is the fast food of medicine. The midlevel provider. These providers have discovered that with the most minimum of medical education, coupled with some on-the-job training, they can deliver the exact same medicine with the exact same results as a doctor, these are essentially medical value meals. Some may think this statement is a slight against these providers, but in fact, what it means is doctors are not any more capable or willing to provide anything better, so why should you pay more, wait longer, and all the other things associated with doctors to get the same thing? The answer is simple, you shouldn’t. Hell…I wouldn’t.
Now some doctors will put the blame on medical malpractice and the threat of getting sued. To which I am just going to call malarkey. According to the yearly Medscape article on malpractice, the doctors who get sued the most, by a vast majority, some 40x%, are primary care providers. The #1 reason is misdiagnosis. The number 2 reason is not apologizing for any “mistakes. Which might be logically surmised as the #1 value meal didn’t work for the patient, and the next attempt will be value meal #2. The next group who are sued the most often are gynecologists. These are doctors who actually have something to worry about… The reason they get sued is reported as parents want somebody to blame for their kid not turning out perfect. Vast arrays of laws have been enacted in favor of these “patients,” so you can reasonably understand the paranoia. OB/Gyn and GP make up more than 70% of all medical lawsuits in the US. All other medical specialties fall between 1-4% respectively.
Because of this paranoia (often unfounded) by doctors, an idea has come about of “the standard of care.” The idea is if you follow the standard of care, you will be found not at fault because you did what another doctor would also do in the same situation. Which is an argument flawed at its core. That is claiming innocence for sucking because most people can be expected to suck. Yea… I am not buying that as what lawyers call an “affirmative defense.”
Still yet other providers practice what I call “the religion of science,” they believe that practicing McMedicine will provide the correct treatment more often than it fails to. Given the best guidelines barely meet the 30% criteria, it is clear that there will still be far more failures than successes, and we haven’t even talked about effectiveness of a given procedure or medication yet. (and we won’t today) The reason I compare this “science” to religion is because its practitioners do not use it as science (To observe in a standard way over time). They use it as religion (to explain the unknown, provide mental security, justify suffering, and explain death). By using scientific papers as a “bible” of sorts, they lose all concept (if they ever had any) that there are limitations to both the scientific method and to medical study. They are in practice not doctors or healthcare providers, but priests of their religion.
So what is the alternative?
It is called “individualized care”. The idea that everyone is different and each case should be examined on its own merits. Most people who wind up in court would like to think their case will be judged on its own merit. Most would seem to like their healthcare to be based off of their own case too.
Now let’s just be clear, even with individualized care, many patients will best be served by a medical value meal. Nobody disputes that. The trade-off though is that there will need to be more doctors. Simply because the time individualized care takes is greater than McMedicine. It requires both more effort and more knowledge on the part of doctors.
The current problems in medical training share blame for McMedicine. 1st, in many countries, the selection process is for those who excel at science, and whose people skills are somewhat lacking, which means you are making doctors out of people predisposed to McMedicine, quantitative thinkers. Another problem is the current residency training. Most doctors in training believe and hear regularly from their mentors, that there is a difference between scientific medicine and clinical medicine. They further expand upon this concept by claiming what is learned in residency is “real or practical” medicine and the things learned in medical school can simply be forgotten as unimportant and impractical.
Individualized care on the other hand requires both the school learning and practical learning to be reconciled together, as two sides of a coin.
If the Mentors of McMedicine cannot do it themselves, they cannot pass it on to their students. If they simply refuse to see its value and pass it on, patient care as a whole suffers as medical progress is stifled.
The hyper-specialization of medicine also promotes the practice of McMedicine. For if the patient does not fit into a specific set of parameters, a specific doctor will or will not see them. But what happens when a patient overlaps or does not fit into these parameters?
Any doctor worth their title and most non-doctors can tell you that a patient must be seen as a whole. But in McMedicine, nobody behaves that way and no doctor is responsible for the whole patient. After all, when will the GP step in and tell a surgeon that a given surgery is not in the best interest of a patient? Never… They just try to clean up any mess after.
I observe every day in clinical practice treatments that are enshrined in protocol and professional guideline. Diagnostics and treatments which do not meet the known basic scientific principles on which they supposedly work. But yet, they are prescribed anyway. Some patients get better in spite of this treatment. Some are not affected either way, and many are probably made worse.
I carry the banner for individualized care. My scientific research is based on discovering why things work. In my many professional presentations I profess we must always ask “why” especially in our treatments. “By what mechanisms do they work?” Usually when I suggest something I am seen as either hopelessly stupid or uneducated, or brilliant. There is no middle ground, and it is easy to predict what the reaction will be by the attitude of the provider. Generally the ones who perfected the system of McMedicine instead of the principles of medicine are quick to negatively criticize and vise versa.
Do you want McMedicine or individualized care?
Does your doctor suck or do you suck as a doctor?
Ultimately these are questions you must answer for yourself.