Why Doctors Hate Science

Ms. Begley: Your editorial does have a significant kernal of truth to it. As physician quality improvement champion at my hospital, we have seen that by simply following well established scientific guidelines (which some physicians refer to as "cookbook medicine"), we have shortened patient length of stay while reducing deaths and complications. This has been also noted in very large population patient registries. Unfortunately, you do demonize the medical profession much more than what is deserved. Many of these other treatments you mention are used by physicians secondary to tremendous patient pressure to do so. Our society has extremely high expectations and seems to want a "quick pill" to fix everything. Studies looking at the pressures of so-called "defensive medicine" clearly also underestimate the fear that we, as physicians, have regarding frivolous lawsutis in the event that these "exceptions" you speak of just might be present.

Ms. Begley: Doctors crave science and research that is why providers read articles daily in order to improve the healthcare system and the care for their patients. Your article should be title Why Doctors hate Lawyers, Medical Malpractice insurers, and Healthcare insurers. Too many doctors now practice cover their butt medicine (CBM), forcing them to order unnecessary tests to aviod the 1/million patient that gets vaginal cancer and therefore the potential for a medical malpractice suit (and therefore they do paps on women with a hysterectomy) . My suggestion is if they create a National healthcare system they should create National Medical Malpractice insurance system with unlimited policy limits, if they don't you may be writing an article titled "Why Doctors hate practicing medicine".

As a psychiatrist I feel qualified to ask Ms. Begley "Have you lost your mind?" The inaccuracies in your article are mind boggling. The assertion that older antipsychotics are as effective as the newer agents is a half truth... they do treat the positive symptoms of schizoprenia but often leave the patient in a zombie-like state. They do nothing to address the negative symptoms such as apathy, emotional withdrawal, alogia, and passivity. On the other hand, the newer agents treat the negative symptoms as well as psychosis.

So Ms. Begley, if it was your daughter who was diagnosed with schizoprenia, would you want her on thorazine (old and cheap) which would leave her a drooling mess, or would you want her on an expensive newer medication ($400-$600 per month) that would give her a chance at a happy and productive life?

I guess it would depend on how much you think her life is worth. As a side note, several of the newer antipsychotics will be available as generics in the next 5 years. Yeah!

As a psychiatrist I feel qualified to ask Ms. Begley "Have you lost your mind"? The inaccurracies in your article are mind boggling. The assertion that older antipsychotics are as effective as the newer, more expensive agents, is a half truth.... the older agents may treat the positive symptoms of schizoprenia, but they often leave the patient in a zombie-like state. They do nothing to address the negative symptoms such as alogia, apathy, passivity and emotional withdrawal. The newer agents not only treat psychosis, but also help with the negative symptoms.

So, Ms Begley, if it was your daughter who is diagnosed with schizoprenia, would you want her on thorazine (old and cheap) which would make her a drooling mess or would you want her on an newer,expensive agent ($400-$600 per month) that would give her a chance at a happy and productive life?

I guess it would depend on what you think her life is worth. As a side note, many of these newer drugs will be generic in the next 5 years, Yeah!

My concern is that the AMA will once again attampt to torpedo any meaningful progress on health care reform. It's got to be one of the most effective unions/advocacy groups in the country. There is hope, however, since right now the country is a little deaf to scare-mongering in general, and this has been the main tactic isn their last campaign... We'll see.

I'm a physician in my fourth year of residency training. Here's a break down of my life with evidence based medicine:

1. Journal Club - once per week, 4 to 5 articles each time (~4 hours / week).
2. UpToDate - I read this two or three times a day, to answer questions I have during the course of the day (~ 3 hrs / week)
3. StatDx - great differential diagnosis resource for radiology. Look at this with every third case or so (~ 3 hrs / week)
4. Textbooks - still the best resource in my specialty. I read one hour every weeknight (~ 5 hrs / week)
5. Conferences - We get one to two hour lectures each day (~ 8 hrs / week)

On average, I'm still under the mandated 80 hour work week, and including moonlighting I probably work 70 hours a week. Add in study time (see above), it doesn't leave much time for my family.

Oh yeah, I've written a book chapter and presented posters at two national meetings this year. My co-residents do the same. I enjoy learning. So do they. We're all very offended by this article. Please issue an apology.

I promise not to write an article in AJR titled "Why Journalists Hate the English Language".

As a physician, I agree that evidence-based medical practice should be the rule, and there is too much influence peddling by big pharma. Unfortunately, I am sure Ms. Begley would be quick to call a malpractice attorney if the right evidence-based medical decision led to the wrong outcome for her. The decision to defer a test/procedure, even one that has less value for routine cases, quickly starts the wheels of the medical malpractice wagon when it is felt by the patient to cause a bad outcome. Some of Ms. Begley's capable, clever, but arrogance-tinged column could have included some words about the need for meaningful tort reform for the medical community. Most of the doctors I know (young and old) are not intellectually lazy, and most don't have time to golf, let alone get enough time with their families. Perhaps we can all take responsibility for improving our health outcomes through better lifestyles, and stop assuming that the medical profession provides a single correct response for every person, every time.

Ms. Pealing:

"...no background into the tenants (sic) of evidence-based medicine..." Please note that the word you want, madam, is "tenets". Look it up. As to recommending that Ms. Begley shadow doctors interacting with patients in situ, well, that could be edifying, but not necessarily in a way complimentary to your profession.

I am impressed by the number of comments opposing Ms. Begley's editorial. As a physician, I strongly believe in evidence-based medicine, and most of my colleagues do, too. Nevertheless, medicine isan ART, not a science. And Ms. Begley really missed a great opportunity to tell the real story of why health care is so expensive, medical liability lawsuits! Defensive medicine is THE driving force behind health care price inflation.

The only people who don't seem to get this are the ones who have never been sued!

B.S....INSURANCE COMPANY MOUTHPIECE..SAVE ON DIAGNOSTIC TEST COSTS, SURGERY, ETC...GEE WE'LL PAY FOR SOME CHIRO OR ACUPUNCTURE...YOU ALL BETTA NOW..GYBYE....

As a radiologist (on salary) but getting to read all those unnecessary studies, while sometimes at least trying to shame colleagues into less radiation on the younger patients, it is necessary to point out that we all live in our own truth, and heaven forfend someone's trying to point out the Emporer's goose bumps. Professions (read guilds if you will) point out that they are organized to set standards for self regulation, which they may ar may not do well, but they also exist to protect their turf and income, always using arguments about protecting the public. The way some of them argue from their own experience rather than the science, we wouldn't be using seatbelts because you just might have trouble releasing it if you were in an accident. We can never solve the problem of health for the American people until the leaders of the political and medical communities, and all other parties are willing to say that medical care has to be rationed. The cost of health care if every person got everything they needed or wanted is more than the gross domestic product (even early last year). It will be CER results that will allow us to make rational decisions, none of which will be easy.

Perhaps an anology to personal protection would help to understand the problem. Let us say everyone has a right not to be harmed by someone else. Most of us get along with societal norms backed up by the local police, or the army if there is an external threat. Some people with means hire body guards, which are unlikey to be affordable for everyone, however, unless we give up a lot of something else. But what is absolutely certain is we can't all be protected in the way the Secret Service protects the President.

There is only one profession I can think of in which the practioner has as much interest in the well being of his or her clients as her or himself, the airline pilot (while in the air).

habits habits habits. I work in the medical field and its not about science or lack there of. It is about time. docotrs spend so little time with each patient and know so little about them that they develop generalized habits of treatment. Once a diagnosis is settled on each individual doctor has a favorite treatment option. I watch the data stream by an could almost tell you offhand by the doctor's name and dx which treatment option will be first.I am sure that, at one time, these doctors had reason to beleive they were doing the best for their paitients but it takes too much time to read the science and wade through the studies so they take broad advice from each other or drug reps or even insurance companies. Mostly they do what they have done again and again and again. Somtimes it is based on good science. Sometimes its based on old science. Who knows sometimes it might have nothing to do with science at all. Given all the information to be waded through and the possible conflict of interest issues with information from insurance and drug companies, I think CER is probably a great idea. If it is not yet popular with doctors, especially older ones, it is because it takes alot of time and energy to reveiw ones habits and if we find some that are bad. well what is the saying ... old habits die hard.

As a radiologist who gets to bill (though only on salary) for all the unnecessary studies and try to shame some into ordering less radiation on our younger patients, it is worthwhile to point out that we all live in our own truth, and heaven forfend anyone trying to point out the emporer's goose bumps. Professions (read guilds, if you were) claim to exist to self regulate, and may or may not do a decent job, but also exist to protect themselves (of course, claiming to protet the public).

The plural of "Anecdote" is not "data". The piece above speaks for itself. The hy;perventilating responses below (which are a significant percentage of responses) speak louder. Doctors do not want CER because the information can only be understood and employed correctly by people with the correct education and experience. Ahem. Wouldn't that be, y'know, DOCTORS? Please, feel free to identify yourself and your colleagues who do not have such education and experience. Your advocacy will greatly educate consumers, though perhaps not in the way you intend. In sum: I feel it is amazing that physicians would assume that ignorance is better than detailed, accurate, truthful information about medicine, medical care, and human health if that information requires education and experience to understand and apply correctly in practice. If this is indeed your contention, why is it that you have not advocated abolishing medical schools to prevent the dissemination of complicated information and protect consumers through an established standard of ignorance about the relative value of, say, brandy, trepanning, and excorcism? You critics certainly seem to be on the cutting edge of medicine today!

CalMD:
You are so right.I bought a copy of Newsweek at O'Hare the other day.What a pathetic waste of $5.Thin as 10 sheets of paper,nothing but tripe and innuendo----NEVER EVER AGAIN!

The number one reason doctors end up ordering unneccesary tests and treatments is because patients and their attorneys demand it. I spend countless hours trying to explain to patients why they don't need antibiotics, tests, referrals, etc. Americans are spoiled and they want their treatments NOW. They are not content to wait and see what happens. And GOD forbid they are the one in a million with a bad outcome. Having been the subject of a lawsuit, wherein the patient had a bad outcome after NOT following my advice, I can only imagine what it will be like when I am sued after a patient has a bad outcome despite following my advice.

The plural of "Anecdote" is not "data". The piece speaks for itself. The comments speak louder. They oppose CER because - out of context - it might not mean what an uneducated person thinks it means. Do they then assert that MDs don't have the education to understand CER in context and how/when it is best applied? And their cure for this problem? Certainly not making sure CER is written up thoroughly & contextually NOR making sure MDs have the education in applying CER. No. They believe that ignorance is much better than true, accurate & precise medical information that happens to need some expertise to be applied correctly. Heaven forfend that we expect doctors to actually HAVE expertise in, y'know, acquiring, understanding, and applying information about medicine and human health.

Doctors do not hate science. Most of us pursue medicine because we have a profound respect for the scientific method and would like nothing more than to practice evidence based medicine. But try telling a patient that there is no real scientific basis for prescribing the latest drug when the pharmaceutical companies are carpet bombing the public with ads for that same drug. Try telling a patient the MRI for their back pain is unnecessary while they have their malpractice lawyer on speed-dial in case there is a delay or missed diagnosis. Because when you use evidence based medicine, statistically there will be some diagnostic misses and delays. You will cover 99% of the population but not the outliers. In a litigious society that demands instant gratification and expects a zero error rate from its physicians, evidence based medicine remains a dangerous proposition. This article is ridiculous in its attempt to manufacture a controversy. The author is so biased and ill informed about the very science which she claims to support. As Newsweek continues to decline in quality and readership, we will no doubt be subjected to more such agonal gasps of "journalism."