The blog and comments point, we think, to a confusing set of principles being considered, perhaps, out of context?
Those comments range from: ACOs will lead to better figuring out what is best (impossible) – to mismatched information regarding a specific clinical case (reasonable). What is striking is that we have medical students worrying about costs of care.
Instead, shouldn’t we be teaching them to understand the value of information for decision-making? Shouldn’t we be teaching them the concepts of co-dependent testing leading to all tests being less useful than we think?
Shouldn’t we be teaching students the concepts of decision-analysis, and thresholds, and patient’s being involved in the decisions? Shouldn’t we be teaching that it is better to know than to think we know? Shouldn’t we be doing studies rather than scratching at the “tragedy of the commons” (so many physicians feasting on the grassy fields of a sick patient)?
Shouldn’t the student be worrying about the consequences of the false positive and false negative tests when a valve is being repaired that carries mortality from a low of about 1% with non-invasive methods rather than invasive that may portend mortality rates up to 10%?
Are we really confused about low and high risk when a heart is about to be assaulted?
Our suggestion to this wonderful, bright and well-meaning student is that it is time to think for yourself and not listen to a medical business that seems to focus on the system and the systems winners and losers in the medical mine fields.
Focus on knowing and making sure patients know as much as you do.
Robert McNutt, MD has been an associate editor at the Journal of the American Medical Association for 12 years and before associate editor at the Journal of General Internal Medicine. He is a professor of Medicine at the University of Wisconsin and Rush University Medical Center.
Nortin M. Hadler, MD is a graduate of Yale College and Harvard Medical School. He joined the faculty of the University of North Carolina in 1973 and has been a professor of medicine and microbioogy/immunology since 1985. His assaults on medicalization and overtreatment appear in many editorials and commentaries and 5 recent monographs: The Last Well Person (MQUP 2004) and UNC Press’ Worried Sick (2008), Stabbed in the Back(2009), Rethinking Aging (2011) and most recently, Citizen Patient (2013).