Is there stuff that you do just because that’s the way
you’ve always done it? I’ll answer for
you – yes.
In many circumstances, this makes sense. For example, I stop my car at red lights just as I have always done. I recommend
that readers do the same as there is an underlying logic for this
recommendation. It is not simply a rote
routine that has no rationale. However,
the particular order that we pour ingredients into a pot when making soup, may
be more random than rational. We follow
the same order we always have, never pausing to wonder why or if there might be
a better way.
And, so it is with many practices and procedures in the
medical profession. Let’s return to the medical condition of diverticulitis,
which I presented on this blog recently. Follow the link, if interested.
For the last several decades, this disease has been treated in
the same way – with antibiotics. This
means that physicians believe this to be an infectious disease – like strep
throat – caused by bacteria. But, the
real reason I think that physicians like me prescribe antibiotics for this
condition as because that’s the way we’ve always done it.
Changing established medical practices is like having an
ocean liner make a U-turn. It’s not
easy. For example, when I was a medical
student, kids with red ear drums, or otitis, were routinely given antibiotics,
assuming that this was a bacterial infection.
But, after a few decades, experts concluded otherwise.
Not Easy to Make a U-Turn
Similarly, I have a strong sense that the established
treatment for diverticulitis may be revised.
The classic understanding of this disease was that this was a bacterial
infection in the wall of the colon. The
theory was that a tiny puncture would develop in one of the diverticula, which
are pouches that are weak points in the colon.
Germs from inside the colon would travel through the puncture site to
the outside wall of the colon, which is usually sterile, and an infection would
start. We prescribe antibiotics and the
patients generally recover well.
But, should the antibiotics really get the credit? What if these patients would have recovered
anyway on their own? I believe many of
them would have. In fact, many patients
who have had diverticulitis, often have had episodes that
recovered spontaneously without having seen a physician.
In fact, a prominent gastroenterology professional society
recently issued guidelines that expressed that not every case of diverticulitis
requires antibiotic treatment. It may
take another 10 years for this recommendation to gain traction.
I’m not abandoning antibiotics for diverticulitis in my
practice yet. But, I am following the
issue closely in the journals. There
needs to be a better reason to do stuff than simple habit and routine – and
that includes reading this blog.