Why Cookbook Medicine Does Work
Coronary artery narrowing … is often treated by the insertion of a metal stent to prop open the vessel. Several studies show that so-called drug eluting stents work better than conventional bare metal stents for these patients. But there’s a catch. If patients don’t dutifully take anti-clotting drugs every day for at least a year, the drug-eluting stents are more likely to clog suddenly and kill them. So if you wanted to improve care for everyone, you’d give drug-eluting stents to the A-plus patients — those who are most likely to take their medications as instructed — and give the cheaper, safer (but less effective) metal stents to the remedial or unresponsive patients. But no clinical guideline makes this point.
Like patients, doctors also have different ability levels. The American Academy of Pediatrics discourages the use of antibiotics for toddlers’ ear infections, on the basis of clinical data showing the drugs don’t work. But as The New England Journal of Medicine recently reported, antibiotics really do help when well-trained doctors are involved. The key, an accompanying editorial dryly pointed out, is “the accuracy of the diagnosis,” since many doctors mistake simple colds for ear infections. In other words, doctors who can’t diagnose ear infections reliably shouldn’t prescribe antibiotics, but those who know their stuff should. Again, no guideline makes this distinction, and the academy caters to the most mediocre doctors with its broad warnings.
This is very good. The whole ACO/ObamaCare approach is, of course, based on cookbook medicine.
Of course medicine caters to the lowest common denominator. The AMA has long held the belief that to acknowledge there are different levels of competency among physicians could undermine patients’ blind faith in the profession. For the longest time physicians were forbidden from advertising their services and were not allowed to claim they were better than their fellow doctor.
The full article is behind a subscription paywall.
Excellent article. The whole thing was worth reading.
Very interestsing post. Everyone should read the entire article.
point 1 – most doctors don’t support the AMA. point 2 – there are varying degrees of ability to be sure, but that applies to every profession out there and most plumbers I know are from word of mouth (good or bad). point 3 – it is correct to say there is no such way to have “cookbook medicine” and every patient is very different, which is why doctors should be left alone to care for their very individual patients by very individual doctors.