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:
- Doctors adapt to change well, and, as a consequence, medicine advances.
- Doctors collaborate as well as anyone.
- 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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