I have a fair amount of contact with the medical field and I see missed diagnoses, misdiagnoses and inappropriate treatment all the time. I don’t know that it’s quite correct to “blame” the doctors though.
The medical system is now largely a field, dominated in each city or region, by a handful of massive provider groups. They are organized for productivity and efficiency, and the groups or organization make stupefyingly large amounts of money. A desire to effect efficiency, which is, I think, largely a financial efficiency, however, has caused doctors to be extremely segmented and limited in what they do. They also are paid on the basis of “production”, which causes them to rush through cases and segment all the more. When fees are based on codes, you don’t get anything for researching or thinking things through. Once you meet the requirements of the procedure, you’re expected to move on to the next patient. You certainly don’t know your patient personally, most of the time. And the more specialized you are, the less you know them.
In talking to doctors who are friendly, I sometimes mention what I call the “Rolling Head Phenomenon”, which goes like this. If, a severed head rolled into an Opthalmologist’s office and, upon examining its eyes, the Opthalmologist saw nothing that fit a category of pathology within his field, he would swear there was nothing wrong with the patient at all. Doctors almost always affirm the truth of the “Rolling Head Phenomenon”, and many regret that their world is like that. Many, many, many will admit that the “art” of medicine has been banished. Only the “science” remains, and that “science” has to fit into categories of manifestations, tests and treatment. No veering to the right or to the left. I discussed with a very talented doctor, the head of his department, the Solzhenitzyn novel “Cancer Ward”, in which an old pre-revolutionary doctor could make most diagnoses, and with uncanny accuracy, just by sitting and having a conversation with the patient, noting the way the patient moved, spoke, his color, the various ways in which the body and the mind give away their secrets. The doctor got really choked up and said “that’s how it should be, but we can’t”.
The Opthalmologist is not paid, encouraged or authorized to note that the patient has been beheaded. And he has forty patients to see that day.
And, while Opthalmologists are pretty well paid, lots of doctors aren’t paid anything like what we out here think they are. The lower the doctor is on the “specialty” chart, the less he/she is paid. The Family Practitioners, who are supposed to make the proper referrals to the proper specialists, have the greatest patient/day burden and are paid the least. No time for the “art” of medicine. No encouragement either.
And while we, or our insurer or Medicare pay immense sums for the simplest things (and much more for more complex things) and the provider groups are awash with wealth, the doctor himself, the nurses, the NPs, get very little of what “they” charge.
Why is this? Part of it has to do with the medical school selection process. Upon questioning, doctors have admitted to me that, at bottom, the ability to get into medical school is almost totally dependent on math skill. If you can’t do the math, you can’t do the chemistry or biology. You might know the heart inside and out and be able, like Solzhenitzyn’s doctor, diagnose with perfection. But if you can’t do math well, you can’t get into medical school to start with. And how many doctors really do chemical analyses to determine what meds to give their patients anyway? A recent study showed that about 30% of all doctors have at least some symptoms of Asperger’s, and that came as no surprise to me at all.
But more than that, it has to do with money. The big medical groups, insurers and the government, all of which encourage intense categorization and narrow focus, and none of which want to hear about the “art” of medicine.
So, while I cannot possibly know how the OPs situation arose, and while I don’t condemn doctors generally or think they’re quacks, (They’re not) as I said, they are doing “assembly line” work and it’s no surprise that things get missed. As I said, I see it all the time.
