Thursday, August 18, 2005

PAREHO SILANG TAMA (They're both right!)



   I used to think that doctors all over the world--as long as they came from a technologically advanced or updated country--treated their patients the same way.

   I thought that they used the same references, the same standards, and the same diagnostic techniques.

   I thought that they gave the same drugs, in the same doses, in the same formulations, using fail-proof algorithms that pinpointed exactly who needed that drug and who didn't.

   I thought that Medicine is one frontier where evidence-based knowledge and principles made sure that patients were treated as scientifically as possible so that there was a minimum of conflict among the caregivers.

   I was wrong. 

   In fact, disagreements are routine among physicians in the same team, much less the same hospital.  Even longtime partners bicker over what to order or not to order for a patient that they had been co-managing for years. 

   This is made official and a little less barbaric in a formal presentation staged supposedly to educate us younger colleages: the Grand Rounds.  But listen closely, strip off the courtesy, and you'll realize that it sounds just like a trial, with a prosecution and a defense.

   Thus it's no wonder that physicians from differing countries can manage their patients so differently, each thinking that they are doing the best for a certain condition even when they're using contradictory methods.  Cases in point:

  • Low blood pressure is considered a sign of health in the United States, but a sign of sickness in Germany
  • Hysterectomies are performed infrequently in France, but is one of the most common major operations in the United States
  • American doctors significantly perform more cardiac bypass operations per capita than do English doctors
  • American doctors are more likely to be aggressive with their approach than their British colleages.  Americans are likely to treat until the treatment is shown to be harmful, while the British tend to wait until the treatment has been shown to be beneficial.  (All from Medicine and Culture by Lynn Payer)

   And yet, the people who live in America, England, Germany, and France have equivalent life expectancy rates, meaning that even some widely divergent medical treatments don't significantly alter the course of disease.  It appears that there is a wide margin for error.  Our systems are actually pretty resilient. 

   So next time you hear your doctors arguing, don't fret right away.  They might both be right, after all.


 




renzguerra liberated at 11:53 am

PPB4iagsU9
March 13, 2006   12:36 AM PST
 
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AvrTZ6W7Mn
March 12, 2006   10:29 AM PST
 
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March 11, 2006   01:03 PM PST
 
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Dr. Oblivion
August 19, 2005   02:18 PM PDT
 
Potato does it again. :)
Friday
August 19, 2005   12:34 AM PDT
 
Hmmm - this is certainly food for thought. Terrific info.
  

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