Changing Physician Behavior - A Difficult Challenge

How many actions do we take in our lives simply because this is how we and others have always done them?   In these instances, shouldn’t we at least pose the question if there might be a superior alternative?   I admire innovators who view the world through a prism that aims to shake up and disrupt the status quo.  You know who I mean; the folks who hear the music in between the notes.  

Medicine is riddled with practices that have remained in place for decades and are, therefore, hard to change. 

• Acute appendicitis is treated with surgery.  Why aren’t antibiotics an option here as they are for other similar infections in the large intestine?
• Diverticulitis has been treated for decades with antibiotics?  Only recently, have experts wondered if this treatment should be reexamined.
• For a generation, children with red eardrums received antibiotics presuming that this was a bacterial infection.   Ultimately, a skeptic started asking questions, and most of these kids are now left to heal on their own.
• During my earlier years of medical practice, we would obtain liver biopsies – an invasive procedure – on patients with unexplained abnormal liver blood tests.  We did this because this is how it was done.   Why has it become rare now?  Because folks who challenged the status quo recognized that the liver biopsy result only rarely changed our medical advice or patient outcomes. 

Of course, this phenomenon is not restricted to the medical profession.  There are many ossified policies and procedures throughout society that are simply left in place.  Has our public school educational system, for example, truly evolved responding to new research?  Seems to me that the high school experience today isn't that different from mine a few decades ago.  In general, we need disrupters who lead us to contemplate other pathways.

Sometimes, we need someone to crack through the concrete.

We physicians try to rely upon sound scientific advice when we are advising you.  But  often there are no medical studies on your specific medical issue.  Or experts may be in conflict on which course of action is preferred.  When the science is absent or in dispute, then we rely upon our judgment and experience.  This is as it should be. This is not the same as practicing by rote as we glide along a groove that has been carved by our predecessors and never challenged. 

Why for so many decades did patients and the medical profession endorse a yearly physical examination with all the trimmings?  Where's the evidence?

Maybe doing something the way it’s always been done works well.  But, if we are to make progress, then we need to take heed of the medical dissenters who are blowing the whistle from time to time.