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.)