How Doctors Think
 

In his new book How Doctors Think, Jerome Groopman critiques contemporary medical education and training. He states that doctors are leaning toward research and statistical evidence, instead of experience and expert opinion, out of laziness and misplaced deference to authority. Consequently, the principle of "evidence before acting" will lead to physicians who stop thinking, stop evaluating each patient as a unique human being, and stop applying their knowledge to the peculiarities of the person before them. Many "bean-counter" doctors recommend treatments that are seemingly supported by statistics but may not be appropriate for the person they are facing. Groopman urges doctors to become more conscious of their own feelings, emotions, responses, and choices, and to promote a greater collaboration with patients.

Groopman also suggests that the values, attitudes, and behavior of a doctor matter far more than the reputation of the institution at which he or she works. He also cautions doctors about the reliance on electronic decision aids, which might actually encourage more mistakes, by distracting the physician away form what should be his primary focus: the patients' own story. Accurate diagnosis requires an investment of time to listen, observe, and think. Groopman's repeated encouragement to the doctor is: "slow down."

There are significant parallels in the field of psychotherapy with the emerging pressure from insurance companies for "evidence-based" practice. The claim that a specific type of psychotherapy should be authorized for a class of symptoms, ignores the uniqueness of the client as well as the character and skill of the specific psychotherapist.

Re: How Doctors Think
 

Some of this is driven by the fear of litigation. If you "step outside the box", litigation seems more likely. It also, in Canada, is driven by the pressure of work, too many patients too few doctors, and the fact that there is a concrete fee schedule which punishes creative thought because it takes much more time. A physician who tries to be a compleat physician (I think that was said by John Donne) is punished compared to the physician who does the "best fit approximation" with the "usually prescribed medication". I fear that all too much of clinical medicine is driven by the monetary interests of insurance companies, and the not so subtle pressure of the pharmaceutical industry which also sponsors medical education seminars. This is also a failing on our part as physicians to place the welfare of the patient ahead of all other concerns. The business model has no place in the physician's consulting room, but it has clawed its way in like a legion of angry demons.

Re: How Doctors Think
 

Excerpt From the NY Times Onlne:

Psychiatrists Top List in Drug Maker Gifts

By GARDINER HARRIS
Published: June 27, 2007

WASHINGTON, June 26 — As states begin to require that drug companies disclose their payments to doctors for lectures and other services, a pattern has emerged: psychiatrists earn more money from drug makers than doctors in any other specialty.

How this money may be influencing psychiatrists and other doctors has become one of the most contentious issues in health care. For instance, the more psychiatrists have earned from drug makers, the more they have prescribed a new class of powerful medicines known as atypical antipsychotics to children, for whom the drugs are especially risky and mostly unapproved.

Vermont officials disclosed Tuesday that drug company payments to psychiatrists in the state more than doubled last year, to an average of $45,692 each from $20,835 in 2005. Antipsychotic medicines are among the largest expenses for the state’s Medicaid program.

Re: How Doctors Think
 

$45,692.00, that is a very disturbing report. There are things I should like to say but discretion would indicate that I should not. It could be seen that such massive exchanges of money has the potential for "wickedness". Surely this could be seen to be inappropriate both professionally by the psychiatrists and in business terms by the American equivalent of our Food and Drug Directorate.

I find this report very troubling. These are all new drugs and any experienced physician knows by hard experience that the real nasty side effects of new medications may not appear for years. What has happened to clinical judgement and the appropriate use of the best proven intervention which may not be a drug at all?

Re: How Doctors Think
 

As an outpatient therapist I get frustrated when a client comes to a session reporting that either "the medication is working," and therefore "I'm done with therapy,' or "My mother died this week, I haven't felt like getting out of bed, I can't sleep or concentrate. I think I need a medication adjustment."

when people rely solely on medication to deal with symptoms, and life, they often enter into a cycle where the medication works for a while, then they build tolerance and, because they haven't been doing anything inwardly or outwardly to make changes in their lives or attitude, they inevitably go running b ack to their psychiatrist for a "medication adjustment."

And when you increase a medication, more often than not, you increase the side effects. then because your health has gone down the toilet and you feel like crap more days than not, you become even more depressed.

The pressure to be medicated comes from all angles and is an easy win in our immediate gratification society.