Breaking The Rules Of Healthcare: Following The Science

Today’s American physicians are benefiting from remarkable medical advances driven by decades of world-leading research and computerized data analysis.

These advances give physicians access to a scientifically proven and optimized approach to 95% of medical problems. Strictly speaking, these approaches give doctors the best chance of successfully resolving a patient’s problem. This is called evidence-based medicine in healthcare.

Studies have shown that if all physicians follow science-based protocols with these algorithms each time, Americans will live healthier and live longer, with fewer complications from both acute and chronic illnesses.

However, doctors often reject data and prefer an outdated and unreliable approach to medical decision making. This article is the fifth in a series called “Breaking the Rules of Healthcare” and explores the unwritten rules that doctors have followed for centuries.

Rule 5: Doctors provide the best care by following intuition

In most medical histories, including most of the 20th century, physicians lacked the scientific know-how needed to prevent and treat most life-threatening illnesses. Because of this, they had little choice but to rely on their medical instincts and previous experience in providing care.

Doctors today still proudly listen to their hearts, insist on following their internal organs, and believe that their intuition produces the best results, despite the data. In many cases, that old assumption has proven to be wrong.

The field of behavioral economics proves how flawed human decision-making is.

Let’s look at an example of the criminal justice system. Evidence-based sentencing (such as evidence-based medicine) helps reduce the negative effects of human prejudice. EBS guidelines aren’t complete, but they can help reduce recidivism, improve public safety, and improve rehabilitation efforts. However, despite the data, most judges continue to believe that their individual judgments are superior.

In contrast to what people in dozens of disciplines think, Nobel Prize-winning psychologist and economist Daniel Kahneman says experts are unaffected by “the influence of irrelevant and irrelevant information.” discovered. In fact, a series of studies on the judicial system found that if judges had the freedom to obey their “internal organs,” the severity of the decision would vary greatly from judge to judge.

Not only that, the sentence also depended on illogical variables such as time and weather. The judge sentenced the defendants to even worse penalties shortly before lunch when the doctor was hungry (and a lighter ruling after their stomach was full). Similarly, rainy days led to worse punishment than sunny days. Intuition isn’t always wrong, but it’s rarely a substitute for science.

When doctors overestimate intuition

Physicians routinely misunderstand the link between instinct accuracy and past experience with the patient. These deficiencies in judgment lead to clinical quality deficiencies and treatment discrepancies.

Take, for example, the famous study of the Oregon Institute, detailed in Michael Lewis’s book. Undo project..

The researchers gave a radiologist 96X-rays of gastric ulcer and asked them to estimate the probability of each cancer. Doctors did not know that we were replicating the study in the mountains. According to the principal investigator, the results were “generally scary.” Doctors are not only inconsistent with each other’s discoveries. They were all inconsistent at least once.

For further evidence of defective intuition, consider prescribing antibiotics. Using the latest research, computer-based algorithms can define when and how antibiotics are useful or unnecessary for patients. However, rather than strictly following science, doctors improperly prescribe these drugs in 30% to 50% of the time, putting patients at risk of life-threatening drug reactions.

The personal preference of the doctor also harms the surgical patient. Doctors often recommend surgery for back pain, despite many studies showing that physiotherapy alone has a 90% chance of being equally effective (and with far fewer complications).

Overall, studies show that the algorithm beats even the best doctors in almost every field: from the prediction of life expectancy of cancer patients, the length of time a patient needs to be hospitalized, sudden infant death. Even the baby’s susceptibility to death syndrome, and so on.

Break the rules: Doctors follow science and listen to patients to provide the best care

Ultimately, doctors who adhere to scientifically derived guidelines make better decisions than if they follow the gut sensation.

However, this new rule does not mean that all patients need to receive exactly the same medical care. Rather, it means that changes in medical practice should reflect differences in patient preferences, not differences between doctors.

To effectively practice the “art of medicine” in the 21st century, doctors need to listen to the values, fears and hopes of their patients. This is much more than in the past.

There are two situations in which a doctor must apply listening skills:

If the risk is too great to compare the two approaches

Determining the amount of insulin to prescribe for diabetics carries significant risks. There is a risk of being too aggressive and too cautious.

On the one hand, overshoots can lead to hypoglycemia. This can cause a diabetic person to faint and crash. This is a fatal risk when riding a bicycle or driving a car. On the other hand, loosening control can cause blood sugar levels to rise excessively, which can harm human blood vessels and organs. This increases the chances of dying early in heart disease. Or you may suffer from renal failure or need amputation.

In this situation, there is no “correct” answer. There is no clinical algorithm that can determine which is worse for the patient. Is it unlikely that you will die in the near future, or is it likely that you will die from future complications? Doctors also cannot make that choice for the patient. Instead, they need to have a detailed conversation and find out what is most important to the individual.

When patients and their families are struggling with end-of-life choices

Recent advances in medicine allow doctors to extend a patient’s lifespan almost indefinitely. But at what point is it better to end the painful and useless intervention than to seize the opportunity for a small but very unlikely treatment opportunity?

What if the chances of healing are 5%, 1%, or one in a million? Is it important if the person is 20 or 90 years old? What if their children and grandchildren are planning to get married next month and all that matters is going to the wedding?

People’s lives and personal tastes are filled with an infinite sequence, which often makes algorithms useless and doctors’ tastes irrelevant. In these situations, the art of listening turns out to be essential.

How to practice the art of listening

Most doctors today do not have the time to have long dialogues about their wishes, fears and values.

But with the help of computer-derived algorithms, a team of clinicians (including pharmacists and nurses) can do things that only doctors could do before. By relying on a team of medical professionals to solve simple problems, doctors can spend time in difficult conversations with patients.

Studies show that if all doctors strictly follow computer-based algorithms, deaths from heart attacks, strokes, and cancer are significantly reduced. For this to become the norm, physicians must break past rules and strictly follow an evidence-based approach. And in the absence of a single best answer, doctors must assess the patient’s uniqueness.