In an ideal world, all our doctors would have the wisdom of Marcus Welby, and all our nurses the compassion of Florence Nightingale. This medical world would be populated with doctors who all graduated No. 1 in their classes, who perform only necessary surgery — and without complications. These doctors would always wash their hands between patients to minimize the spread of infection. All medical research would be funded by nonprofit foundations to preclude bias. And, of course, all doctors would be salaried to avoid perverse incentives to do too much to too many.
Recently, the United States Preventive Services Task Force recommended against prostate-cancer screening, saying it doesn’t save lives overall and often leads to additional tests or treatments that do harm. Two years ago, the same task force, which is made up of nonfederal experts in primary care, recommended against screening mammography for women in their 40s.
What would Dr. Welby and Nurse Nightingale have said about the task force recommendations? I believe they would have endorsed them, because they are carefully researched and objective.
Yet both recommendations have been met with widespread protest. The task force has been accused of rationing — the dirtiest word in American medicine.
Why? Because a chasm separates the idealized world of American medical practice and our current reality.
