3 common misconceptions about doctors

In the current climate of health care reform, it is important to understand doctors and the work they do. I have found 3 common misconceptions, held even by doctors themselves, concerning the job of being a doctor.

The first is the idea that doctors are conservative, resistant to change. Facts show that doctors deal with change all the time. They are familiar with the concept of change for change’s sake and how good ideas sometimes fail. They know that all change is not improvement and that the process is herky-jerky, but over the long term trends upwards inexorably. The basis of this is the scientific process, the hallowed double blind placebo controlled studies. Using the scientific process, medicine advances by trial and error. In a manner analogous to the free market, the better is retained and the worse falls to disuse. The end result is progress. To see this, just compare testing, medicine and surgeries from 10 years ago to today. Doctors adapt to change better than most any other occupation you can name.

With political health care reform, ideas that appear good, but fail in practice, are actually retained and flourish. Basically, politicians argue the idea is good, we just need to tweak things, work harder, collaborate more, use computers and ascend a learning curve. Ideas are not tested out before they are put into practice. With the scientific process, you would test an idea first. Probably you would need IRB approval and an informed consent form for the people you are experimenting on. Not so with the political process. The end results of their mismanagement are increased bureaucracy, inefficiencies and higher costs.

The second is the idea that doctors don’t collaborate well. As a consultant, my job is to consult and collaborate, often with people I have never met concerning the health of their patient. It’s not just me. This is a system wide thing. Doctors collaborate as well or better than most other occupations.

The third is the idea that there is one correct way to do things. Our medical professors teach us this and it is wrong. In fact, in health care, there are many ways to get from A to B, and honest disagreements about the best way to do this. This is the origin of the geographic variations in health care utilization according to the health economist Charles Phelps. An allied misconception is that if geographic variation is eliminated, it will save a lot of money. It probably won’t, according to the health economist Miron Stano. The problem with health care costs is increased bureaucracy (Gammon’s law) and high prices. Increased bureaucracy arises from external pressures, like bad governmental health care policy with increased paperwork, and internal pressures (Parkinson’s Law). The health economist Uwe Reinhardt and his colleagues argue on the other hand that “It’s the prices, stupid!”, which no one who has been to a US emergency room and paid cash could argue with.

Here is what the data show:

  1. Doctors adapt to change well, and, as a consequence, medicine advances.
  2. Doctors collaborate as well as anyone.
  3. The problem with health care is not doctors, it’s increased bureaucracy and high prices, due to the government, health care administrators and the pharmaceutical industry. I am not saying doctors don’t have problems with the profession or that there couldn’t be improvements.

Bradley Evans is a neurologist. 

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  • http://twitter.com/redbirds12 John C. Key MD

    The misconception that I encounter most is more worldly but equally frustrating: “All doctors are wealthy”.  This may have been true, or more true, 30 years ago but is not true today.  Yet most of the general population seems to feel that it is great for doctors to go unpaid, to have their compensation decreased, yet pay 20% more for most goods and services. It’s just another component of our broken system.

    • http://www.mywhitecoatisonfire.com/ Lumi St. Claire

      Amen, John.

      • SidewaysShrink

        I agree with kjindal and Lumi but you are using the rhetoric of then 1% who accuse others who want tax parity of “envy”.  These guys really did not put in any sweat and training in like us, or extend themselves into debt.  They went to school, sure, but being an MBA that Daddy paid for is nothing like what most of us did and are still paying for.  Yes, they want us to give away our services for free and some states have talked about linking licensure with Medicare/Medicaid accreditation, but that is because they want health care providers of all kinds to be in the newly burgeoning 99%.  In the 99%, also known as the working class, you do not have choices about how you work, the conditions you work in, how much you are paid.  What was altruism and zealotry of 60-70 work weeks is teetering on the edge of becoming wage/student loan servitude:  the behaviors are the same but there is no choice in the matter.  The Boomers are retiring leaving us behind to take care of them for pennies on the dollar we borrowed in student loans….

    • kjindal

      It’s part of the new American “fairness” doctrine, validating the enslavement of those who have put in the blood, sweat, and years of hard work and training, to redistribute to those generally lazier noncontributors to society; a punishment of a modicum of success out of pure jealousy.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    The other misconception that is the bottom of it all is that doctors are more concerned with their earnings than the welfare of their patients. This notion is subtly propagated by those who want to change the system without input from practicing physicians and without having to submit to the rigors of the scientific method. It is at the heart of the war on fee-for-service, the drive to eliminate private practice, the value based payment schemes and the general push to transition the locus of trust from the doctor-patient relationship to a nebulous system of computers and corporate and governmental population overseers. 

  • http://www.facebook.com/people/Swami-Nathan/100001175507847 Swami Nathan

     Will the Doctors adapt to change which involves ‘scientifically proven alternate therapies’ (who has the financial incentive to fund the expensive clinical trials to prove such things is another bottleneck) showing less need for doctor care if the patient is willing to change his life style to fit the alternate therapies?

    • http://dinosaurmusings.wordpress.com/ #1 Dinosaur

      Oops, I hear quacking. The difference between alternative practitioners and real doctors is that doctors (eventually) stop doing procedures proven not to work. Hard core alties refuse to believe negative studies, either misinterpreting the results, or insisting that their therapies “can’t be proven with standard scientific methods”. Acupuncture, chiropractic, and homeopathy have in fact been studied extensively (at great public expense; see NCCAM) and basically been proven not to work. 

      If all you’re talking about is lifestyle modifications, sure, doctors would have much less work if everyone exercised, ate less, and stopped smoking. This is not a bad thing, unless you’re working under the further misconception pointed out by Margalit below (doctors are more interested in money than their patients’ wellbeing.) If you’re talking about herbs and supplements, see above.

  • http://twitter.com/ManamanaHi Dr. Sharon Takiguchi

    You are correct that doctors do collaborate well with other doctors, but your comment is egocentric as medical doctors do not always collaborate well with patients and other healthcare professionals. 

  • johnmh3579274321

    Dear nice Kevin, MD, I hope that you are in good health. I would like to see thoughts about specific scientific experiments which support specific statements, in these comments. Scientific American, eScience, Science News, Science Daily, and other websites talk about scientific experiments. Thank you. 

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