Mysteries of modern health care

by Walter Olson on January 8, 2013

“In the topsy-turvy world of health care, doctors and hospitals have a very powerful influence on how you are treated,” he [a university investigator] said. [San Jose Mercury-News] Topsy-turvy indeed — who would have guessed such a thing? (& InsureBlog)

{ 3 comments }

1 John David Galt 01.08.13 at 11:18 pm

The doctors and hospital administrators who behave as if they, not we, are the customers would have guessed it. And they (along with nanny government) are the reason it needs to be fixed. Yes, that’s topsy-turvy.

2 Bill Poser 01.11.13 at 5:26 am

Actually, I think you’ve misunderstood that quotation. The contrast is not between doctors and hospitals and, say, patients; rather it is between doctors and hospitals and science. The point is that the treatment is not determined purely by medical science but that there is considerable variation in how aggressively different hospitals and doctors approach the problems of dying patients.

3 John Fembup 01.12.13 at 8:24 am

“The point is that the treatment is not determined purely by medical science but that there is considerable variation in how aggressively different hospitals and doctors approach the problems of dying patients.”

What you say is true, but that’s not exactly what Dr. Fisher was quoted in the article as saying. I think his comment is about the bigger issue whether “science” (e.g., evidence-based medicine) should be much more in control of clinical decisions.

When Dr. Fisher states that the world is “topsy-turvy” the reason he gives is that physicians and hospitals have a powerful influence on how one is treated. That suggests the world could be turned right-side-up by significantly diminishing doctors’ and hospitals’ influence, which could be accomplished by making clinicians’ decisions significantly more subject to “science”.

If the science were based only on me I might feel differently. But science is knowledge of whole populations. Different individuals react differently to “the same” medications. Body temperature naturally varies from individual to individual. (On average Americans have one testicle and one ovary.) A scientific fact about a population may not be a fact for a specific individual. I want my physician to treat primarily me – and not primarily the population represented by the science. And subject to that, your statement above makes perfect sense.

That’s why I don’t agree that the present situation is necessarily “topsy-turvy” even when there may be gaps in physicians’ scientific knowledge. I suspect that Dr. Fisher was misquoted. If not, then I believe his comment overstated the optimal relationship between the “science” and the clinician.

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