Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The unintended consequences of well meaning regulation

Robert Centor, MD
Policy
June 18, 2013
Share
Tweet
Share

Why do we never consider unintended consequences? Whether we are thinking of legislation or physician led guideline panels, or governing bodies (like ACGME), the lack of consideration of unintended consequences remains mind numbing.

Let me provide some examples.

Please read this articles about how the war on drugs has fueled the hepatitis C epidemic. One could also argue that this war damages more young people than the drugs themselves.

Many illicit drugs do damage to users. But the laws impact both the users and innocent bystanders. The laws put too many young adults in prison. The laws force a black market, and for many drugs stimulate crime. Advocating for de-criminalization is not advocating for drug use, but rather focusing on preventing complications (like infections) and on programs to help patients stop drug use.

Next read any number of blog posts on performance measures. Let me give 3 quick examples of poorly considered performance measures.

The most obvious is the 4-hour pneumonia rule that led to increased unnecessary antibiotic usage. Trying to drive HgbA1c below 7% for every patient puts some patients at risk from hypoglycemia and from drug side effects. In Great Britain, paying physicians to decrease appointment waiting time induced less continuity of care (with the primary physician).

Finally, we are learning what many predicted. The work hour restrictions for residents are hampering medical education: For New Doctors, 8 Minutes Per Patient.

In example after example, thoughtful critics receive minimal lip service. Each group of decision makers moved forward, damn the torpedoes, full speed ahead.

Why?

I believe that the big problem is the affect heuristic. In short, that decision making heuristic says that if you like an idea, you over value the benefits, and underestimate the harms. We must figure out how to work around this undervalued concept. We desperately need to develop decision making processes that focus on both benefits and harms and develop logical means for balancing the benefits and harms.

Unfortunately, I remain pessimistic. Decision making bodies have biases. Until they understand their biases, we will have the problem of unfortunate, unnecessary and potential dangerous unintended consequences.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

Prev

Sexual health issues should be normalized in the exam room

June 18, 2013 Kevin 6
…
Next

Psychiatric patients don't fit the usual medical mold in the ED

June 18, 2013 Kevin 9
…

Tagged as: Primary Care, Public Health & Policy

Post navigation

< Previous Post
Sexual health issues should be normalized in the exam room
Next Post >
Psychiatric patients don't fit the usual medical mold in the ED

ADVERTISEMENT

More by Robert Centor, MD

  • When the problem representation and the illness script do not match

    Robert Centor, MD
  • Think of diagnostic excellence as playing smooth jazz

    Robert Centor, MD
  • When constipation pain was worse than cancer pain

    Robert Centor, MD

More in Policy

  • Unused IV catheters cost U.S. hospitals billions

    Piyush Pillarisetti
  • Why your health care dashboard isn’t working and how to fix it

    Dave Cummings, RN
  • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

    Robert E. White, Jr. & The Doctors Company
  • How new loan caps could destroy diversity in medical education

    Caleb Andrus-Gazyeva
  • Why transplant equity requires more than access

    Zamra Amjid, DHSc, MHA
  • Ideology, not evidence, fuels the anti-trans agenda

    Andie Riffer, PhD and Shawn E. Parra, LCSW, MSW
  • Most Popular

  • Past Week

    • Why your clinic waiting room may affect patient outcomes

      Ziya Altug, PT, DPT and Shirish Sachdeva, PT, DPT | Conditions
    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • The ethical crossroads of medicine and legislation

      M. Bennet Broner, PhD | Conditions
    • A doctor’s guide to preparing for your death

      Joseph Pepe, MD | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • A doctor’s guide to preparing for your death

      Joseph Pepe, MD | Physician
    • Coconut oil’s role in Alzheimer’s and depression

      Marc Arginteanu, MD | Conditions
    • How policy and stigma block addiction treatment

      Mariana Ndrio, MD | Physician
    • Unused IV catheters cost U.S. hospitals billions

      Piyush Pillarisetti | Policy
    • Why U.S. universities should adopt a standard pre-med major [PODCAST]

      The Podcast by KevinMD | Podcast
    • Ancient health secrets for modern life

      Larry Kaskel, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 12 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why your clinic waiting room may affect patient outcomes

      Ziya Altug, PT, DPT and Shirish Sachdeva, PT, DPT | Conditions
    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • The ethical crossroads of medicine and legislation

      M. Bennet Broner, PhD | Conditions
    • A doctor’s guide to preparing for your death

      Joseph Pepe, MD | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • A doctor’s guide to preparing for your death

      Joseph Pepe, MD | Physician
    • Coconut oil’s role in Alzheimer’s and depression

      Marc Arginteanu, MD | Conditions
    • How policy and stigma block addiction treatment

      Mariana Ndrio, MD | Physician
    • Unused IV catheters cost U.S. hospitals billions

      Piyush Pillarisetti | Policy
    • Why U.S. universities should adopt a standard pre-med major [PODCAST]

      The Podcast by KevinMD | Podcast
    • Ancient health secrets for modern life

      Larry Kaskel, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The unintended consequences of well meaning regulation
12 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...