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Dr. Contrarian's Guide to Medical Practice

In the midst of a growing hallelujah chorus of health plans and researchers singing the praises of evidence-based medicine as the antidote for what ails the health care industry, we sought out the opinion of Dr. Contrarian, purveyor of all things wild and wacky, on whether physicians would eventually get on board and embrace a set of clinical protocols based on scientific research to improve quality of care.

Dr. Contrarian, who always Thinks Otherwise, reminded us that evidence-based medicine is only one of the many varieties of medical practice, and a fairly minor one at that. A proper understanding of the long term future of American health care requires sufficient appreciation of the alternatives:

Evidence-based medicine. Rigorous clinical studies and scientific research establish the algorithms of care. Say you're a hospital CEO. Evidence indicates that heart attack patients who go home with a prescription for beta blockers and plenty of follow-up have lower hospital readmission rates than patients who don't receive beta blockers. Evidence further indicates that lower readmission rates translate into fewer surgeries and decreasing hospital revenues. Which evidence is more compelling, especially for your career?

Judgment-based medicine. What you are supposed to do when you consider the evidence. If Dr. Contrarian had a dollar for every physician who said, "Medicine is more art than science," or "There's no substitute for individual judgment," he would be on Easy Street today. The fact is, there's no accounting for judgment, especially when it's bad.

God-based medicine. What happens when physicians come to believe their judgment is infallible. What happens when patients come to believe in the infallibility of physicians. Inevitably, we come away disappointed when we seek God in the pronouncements and practices of others.

Faith-based medicine. Faith that the stuff we do in medicine is going to make a difference. Faith that physicians and other health care professionals actually know what they're doing. Most physicians know that 80 percent of the people they see are going to get better, no matter what they do. That, too, is a calculation based partly on faith.

Inertia-based medicine. Easily the most dominant mode of medical practice, and of all human practice generally. Yes, it might be good to change the way we do practice medicine, but maybe tomorrow. The immediate goal is to slog through the day.

Greed-based medicine. The logical consequence of the transformation of American health care into a vast industry. How many surgical procedures do you have to perform in a year to rake in a $500K salary? How many sick people do you have to drop from your insurance plan to reduce risk exposure and increase profitability?

Gee Whiz-based medicine. We add to a growing list of medical interventions because we have all this amazing technology and are duty-bound to use it. In the not-too-distant future, when you reach 80 years of age and haven't had a hip replacement, plastic surgery or a genetic scan, there will be something profoundly wrong with you. Humans are destined to be replaced by machines. The rest is sub text.

Gender-based medicine. I spend quality time with my patients because I am an empathetic, caring woman who is in touch with the physical and emotional needs of others. You, on the other hand, are a dominant alpha male who is arrogant, self-absorbed and totally unable to communicate. Oh Happy Day when most of the nation's physicians are women. Just give the men some nifty high tech toys to play with. They'll be happy.

Dr. Contrarian invites readers to add to this preliminary list with their own favorite variety of medical practice. Perhaps he will use it in his highly anticipated book, All Skewed Up: A Contrarian's Guide to the Universe, which lays out how the world really works, and why the best we can hope for is a life of constant puzzlement.

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*The Drift reflects the views of the author, and does not represent the official view of SLHI's Board of Trustee and staff.