Sunday, October 16, 2016

The Importance of Medical Judgement - Part II

Last week, I offered up an argument on why medical judgement means more than medical knowledge.  In other words, being a really, really smart doctor is not the essential qualification for practicing excellent medicine.  I ended last week’s post with some examples of medical ads that are familiar to all of us. 

Here are some ads and slogans that you won’t see on highway billboards or in press advertisements.

·       Bring your back pain to our orthopedists.  They probably won’t operate on you since most back pain is not effectively treated surgically.  You don’t want unnecessary surgery, do you?

·       Wanna lose weight?  Consult with our bariatric surgeons who will refer you to one of our certified dieticians so you can endure yet another diet.  Who wants a trigger happy surgeon anyway?

·       Come to our oncology center for a second opinion.  Don’t expect any new treatments, since ‘promising’ experimental treatments are exactly that – experiments.  We’re not rolling the dice with your life. 

The public equates technology and active medical intervention with excellent medical quality.  That’s why ad copy from doctors and hospitals often uses phrases such as, cutting edge, robotic, laser, state-of-the-art, etc.  Most patients would not react as positively to an ad championing conservative doctors who don’t order too many tests or write many prescriptions, even if these practitioners are better physicians.

Why Medical Judgement is Like Steak.  Read on.

We tend to respect medical professional who do stuff more than we do those who don’t do stuff or just slug it out preventing disease.   Which doctor will command more respect in the community, a cardiac surgeon who is renowned for his expert craftsmanship on performing bypass surgeries, or a family physician who succeeds in getting patients to quit cigarettes so they never need bypass operations?

Sure, I know how to do a colonoscopy, after having done 30,000 of them.  Any technician can be taught how to do this procedure skillfully.  But is this enough? Patients deserve sound medical judgment, not just technical prowess.  When you see your gastroenterologist in the office, and colonoscopy enters the conversation, judgement needs to be in the room also.

·       Is colonoscopy truly necessary?
·       Is there a better or safer test that should be done instead?
·       Are the risks of colonoscopy too high considering my personal medical circumstances?
·       Has my doctor explained how the colonoscopy results will affect my care? 

This last item is absolutely critical.  If your doctor orders a test, make sure that you are persuaded that the test result will shape or change your medical advice.  For example, if your doctor is going to recommend exercise and medications for your new onset of back pain as initial treatment, then an MRI of the back doesn’t make sense.

I hope that I have given you enough knowledge to make good judgments.

Medical knowledge has the sizzle.  But, medical judgement is the steak.

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