Leisure, Lifestyle & Wellness
When doctors assume that they know what a patient wants

Doctors often assume that they know what a patient wants; leading them to recommend the treatment, they know best. However, doctors, like all others, are fallible. If this is understood then the question of lawyers coming into the picture does not arise

 

From heart surgery to prostate care, the medical industry knows little about which common treatments really work. The signs are not very encouraging. David Eddy, a former professor of cardiovascular surgery at the Stanford, who left his job and got his PhD in mathematics from Duke’s university, has been struggling to get to the bottom of this uncertainty, without much success though. He has developed a computer model “Archimedesmodel.com” that has given him an insight into our failings in this field. 
 
Nobody seemed to bother about my pleadings in the last 40 years that doctors have been barking up the wrong tree and were taking patients up the garden path to the mirage of omnipotent treatment strategies. Eddy showed that the conventional approach to treating diabetes, cholesterol, high blood pressure etc. did little to prevent the heart attacks and strokes that are the predicted complications. 
 
“Even today, with a high-tech medical-care system that costs the nation $2 trillion a year (in the US alone), there is little or no evidence that many widely used treatments and procedures actually work better than various cheaper alternatives,” feels David.  He traced one common practice -- preventing women from giving birth vaginally if they had previously had a caesarean -- to the recommendation of one lone doctor.  Eddy liked to cite a figure that only 15% of what doctors did was backed by hard evidence. 
 
Medicine is doing somewhat better in recognizing the problem, but in solving it, unfortunately, no.  Because there are no definitive answers, you are at the whim of where you are and who you talk to. Take cancer for example. If you go to a surgeon, and he'll probably recommend surgery. Go to a radiologist, and the chances are high of getting radiation instead. Doctors often assume that they know what a patient wants; leading them to recommend the treatment they know best. It is really troubling to know that many doctors hold not just a professional interest in which treatment to offer, but a financial one as well.  The conventional wisdom in prostate cancer -- that surgery is the gold standard and the best chance for a cure -- is unsustainable. Strangely enough, however, the choice may not matter very much. There really is no evidence to suggest that one treatment is better than another.
 
As a developed world, westerners always want the best, the most recent technology. We, in India, ape them anyway, thanks to Centuries of dominance. They spend a huge amount developing it, and we get a big increase in supply. "There is a massive amount of spending on things that really don't help patients, and even put them at greater risk. Everyone that's informed on the topic knows it, but it is such a scary thing to discuss that people are not willing to talk about it openly”, wrote one CEO of a large HMO.  
 
The antibiotic resistance is a time bomb, which could burst any moment. A lot of things we absolutely believe in at the moment, based on our intuition, are ultimately absolutely wrong. Large randomized studies did not deliver the goods as expected because we have been treating the human body as bio-medical electromechanical machine like a car engine. Human body is much more complicated and follows totally different rules of the game. We need to think afresh. 
 
So it's no surprise that up to one-third of clinical studies lead to conclusions that are later overturned, according to a paper in JAMA.  With proof about medical outcomes lacking, one possible solution is educating patients about the uncertainties. "The popular version of evidence-based medicine is about proving things," "but it is really about transparency -- being clear about what we know and don't know. 
 
“Medical science, or for that matter, any other science, can never be certain of the future unless the total knowledge of the initial state of the organism is known. Doctors have been predicting the unpredictable all through.  Medical profession is not aware of our inability to predict the future of the human organism under any circumstance with certainty. Uncertainty is the only certainty in human health and disease.  If one has been in practice for a considerable time, one would have noticed that even in trivial illnesses, where one could be sure of a positive outcome, the patient surprisingly could even meet his maker.
 
Let us educate the public that doctors are not capable of predicting the future in any disease set up and, therefore, doctors should have faith and hope even in the most desperate situations. Doctors, like all others, are fallible. If this is understood then the question of lawyers coming into the picture does not arise. Empathetic transparent communication and good record keeping are the best insurance against malpractice suits. 
 
(Professor Dr BM Hegde, a Padma Bhushan awardee in 2010, is an MD, PhD, FRCP (London, Edinburgh, Glasgow & Dublin), FACC and FAMS. He is also Editor-in-Chief of the Journal of the Science of Healing Outcomes, chairman of the State Health Society's Expert Committee, Govt of Bihar, Patna. He is former Vice Chancellor of Manipal University at Mangalore and former professor for Cardiology of the Middlesex Hospital Medical School, University of London.)
 

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COMMENTS

Balaji

2 years ago

Of course Doctors don't know. They exist only for last 200-300 years. And humans from millians of years.
On same topic Good read book -
"Being Mortal"
http://atulgawande.com/book/being-mortal...

Cheers.
Balaji

Charles Carvalho

2 years ago

This reminds me of what Charlie Munger says - To a man with a hammer, everything looks like a nail! Doctor, would love some suggestions around the possible short term solutions for this problem. A doctor helpline by Moneylife?! Not to complain but to recommend people to doctors who specialize in holistic care and wellness rather than in prescribing medicines and surgery. In the long term this requires a major jolt from the government which we can all hope and pray for.

MG Warrier

2 years ago

Thank you, Dr Hegde, for the effort to create awareness about the grey areas in healthcare. The gradual disappearance of the concept of Family Doctor in India and the transfer of healthcare responsibilities to machines and specialists are causing avoidable agony to those who approach hospitals for medical attention. As for the bus conductor the passenger is a 'ticket', medical profession and pharmaceutical industry are becoming parasites on the ill-health. Some self-regulation and some amount of sharing and caring from government can reduce the agony. I have tried to cover some aspects of universal healthcare in an article sometime back in Moneylife which has been included in my book "Banking, Reforms & Corruption: Development Issues in 21st Century India"

SEBI chief says financial sector accounts for bulk of corporate bond issuances

Companies which are supposed to be part of the 'Make in India' campaign and who are supposed to be in need of resources, are still quite some distance away from tapping the bond market, Sinha said

 

With 'Make in India' becoming a major thrust area for the Government, Securities and Exchange Board of India (SEBI) chairman UK Sinha on Wednesday said financial sector accounts for the bulk of money raised through issue of corporate bonds while indicating that the manufacturing sector was getting left out.
 
"Those companies which are supposed to be part of the 'Make in India' campaign, who are supposed to be needing resources, they are still quite some distance away from tapping the bond market," Sinha said addressing an event in Mumbai.
 
He said the banks and financial sector account for over 70% of the issuances in the corporate bond market, which has witnessed a 19% growth in issuances every year since FY05.
 
The Modi-led Government launched the 'Make in India' initiative last year to transform the country into a manufacturing hub, to help generate employment in the country and also help establish it as an exporting powerhouse.
 
Making a case for greater transparency, Sinha said that over 95% of the bonds are private placements, even though mechanisms of reporting and listing are available with us.
 
The financial sector regulators are committed to help the corporate bond markets, Sinha said, enumerating the measures taken by SEBI, RBI and insurance watchdog Irda for the same.
 
On the progress by the Employees Provident Fund Organisations (EPFO) with regard to play in the corporate bond markets, Sinha said a "major change is required" in this.
 
The bulk of investments undertaken by the EPFOs are in public financial institutions, he said, adding that the 13% share of the EPFO in the corporate bond market also includes their investments in banks' fixed deposits.
 
"If we carefully analyse, this is one area where major change is required. I am sure government and other agencies are working towards it, but this is an area where a lot of improvement is needed," he said.
 
On the newly introduced real estate investment trusts (REITs), Sinha said there will be some launches "very soon", even though the industry has expressed concerns on the taxation front.
 
"We are hoping that very soon, we will have some companies who are going to launch their REITs...My impression is that whatever happens on the tax front, by any additional measures, there is good appetite for REITs to come through," he said.
 

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