| Thursday, August 18, 2005 | ||||||||||||||||||||||||||||||||||||
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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:
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.
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