Doctor Hypocrisy

The fact that your life would be easier if you could trust someone does not make that person trustworthy.  Doctors are a good example.  Wednesday’s Post:

The first-of-its-kind survey of more than 1,600 physicians, published today in the Annals of Internal Medicine, found that 45 percent said they did not always report an incompetent or impaired colleague to the appropriate authorities — even though 96 percent agreed that doctors should turn in such people.

Moreover, 46 percent said they had failed to report at least one serious medical error that they knew about, despite the fact that 93 percent of doctors said physicians should report all significant medical errors that they observe. …

A majority said they would refer patients to an imaging facility in which they had a financial interest, but only 24 percent would inform patients of that financial tie.  Yet 96 percent told researchers that doctors should put their patients’ welfare above their own financial interests.

Also, more than a third of physicians, 36 percent, said they would order an unneeded MRI (magnetic resonance imaging) test if it were requested by a patient with low back pain, though most doctors say they do not want to waste scarce resources.

And while 93 percent said doctors should provide necessary medical care regardless of a patient’s ability to pay, only 69 percent currently accept uninsured patients who are unable to pay.

I doubt doctors are much different from other professionals in succumbing to such temptations.  The problem is that people want to believe that doctors are somehow different, and can be trusted just because they are doctors.  Which lets them get away with …

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  • Konrad

    Get away with what, exactly?

  • burger flipper

    cliffhangers and unannounced 2-parters. I feel like I’m watching Falcon’s Crest.

  • Caledonian

    …pretending to be authorities far beyond their actual expertise.

    I’ve noticed this in arguments on the web about medical matters. Most people are completely unwilling to evaluate logical arguments on the subject and will defend existing practices to the point of absurdity, seemingly by default.

    Most doctors aren’t willing to analyze what they do either, in my experience, but at least there are good reasons for that.

  • gutzperson

    What about my lovely doctor friends, who smoke and drink too much. One of them was an emergency doctor who regularly drank way too much after working hours to cope with stress. (He also told me that I would die because of my tachycardia. I had hurt him when I was younger, did not want to go to bed with him). One of them is my best friend, she smokes 20 cigarettes a day, while she has to ask people to get off smoking. Another one is on some form of drugs, don’t know if it is some morphine. Another loves goose liver pate and all the other (lovely) fatty substances.
    It is a hard life for doctors, nowadays.

  • Jor

    In terms of imaging, a lot of the problems are that the financial incentives for physicians are not lined up with delivering efficient care. The new Medicare report on reimbursement notes that the system actually punishes physicians that use resources wisely.

  • peatey

    Which lets them get away with … murderous malpractice?

  • http://hanson.gmu.edu Robin Hanson

    Konrad, Caledonian and peatey finished the sentence adequately.

  • Stuart Armstrong

    Which lets them get away with …

    Violating trust and keeping their image intact.

    But there’s something very interesting about the ways doctor’s are flawed. With one exception, the flaws are not something that a current patient of the doctor would understand as a betrayal (the one exception is a majority said they would refer patients to an imaging facility in which they had a financial interest, but that’s borderline – as long as the doctor convinces himself that the imaging is needed, then he can justify to himself that that isn’t a violation of trust).

    It seems that doctors are strongly motivated to avoid looking a patient in the eye and doing something that patient would take as a betrayal. It seems the statement “I can trust my doctor” is more true than “doctors can be trusted”.

    Incidentally, is the statistic 69 percent currently accept uninsured patients who are unable to pay reliable? That seems absurdly altruistic…

  • Stuart Armstrong

    It seems the statement “I can trust my doctor” is more true than “doctors can be trusted”.

    And that might be why it’s so hard to get people to see that there’s a problem…

  • douglas

    When I worked in a hospital I saw some things that shouldn’t be. A major source of the difficulty, it seems to me, is the way doctors who do get reported are treated.
    For example, a doctor who has been giving excellent care for years might make a mistake. Other doctors might want to report that mistake, but if they do a malpractice suit may follow, ruining a good doctors career and driving up all their costs of doing business.
    Another scenario is when the doctors figure this not so good doctor is better than none at all. This is a sad situation caused by barriers to entry to the medical profession.
    And of course there are those who just get away with murderous malpractice- (a smaller subset of the total than one might expect from the statistics quoted).

  • Jor

    Stuart: I’d say its probably realistic for patients that have been seeing the same doctor for 5-10 years, then lose health insurance for a year or two. The physician they already have a relationship with, will often continue seeing them at minimal charge. In that context, I’d believe the 70% statistic.

  • http://entitledtoanopinion.wordpress.com/ TGGP

    Mark Miller suggests using the term “vulnerable” in place of “trusted” in certain situations.

  • http://blog.greenideas.com botogol

    problem is : if we fired every doctor who ever made a bad mistake… then we’d have no doctors. So we’d be worse off.

    So:
    – too few cover ups: maxuimum exposure, too few doctors
    – too many cover ups: incompetent doctors (who make more-than-average-errors) continue to practive.

    With some assumptions about error rates It shouldn’t be too hard to construct a mathematical model that shows what is the optimum level of cover-up.

  • Ben Jones

    It’s wonderful how a lawyer schmoozing and lying his way through his profession is pleasant confirmation of our steretypes, but a doctor referring a patient to a centre in which he has an interest is a massive shock. It’s akin to calling Britney a terrible mother while stuffing your kid with chips and white bread. People are not automata. They will protect their own interests, they will be lazy, they will lie, and they will be contradictory. They will do this whether they are lawyers, doctors, aid workers or soldiers. Should we scrutinise the medical profession due to its immense power? Yes. Should we expect a higher moral standard of doctors than we demonstrate in our daily lives? Good luck.

  • Ben Jones

    Doctor hypocrisy? Surely the title you were looking for was ‘Hippocrisy’.

    [Very pleased with that one!]

  • Alexa Blue

    Ben: Perhaps we should expect a lower moral standard of doctors (and reward them accordingly).