The Doctor Is In (the Dark)

Most of us believe that if a doctor recommends a particular treatment he or she has a reason to think it’ll be effective. Not so.

A recent New York Times article penned by H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, asserts that a lot of medical treatment is basically a shot in the dark.

“The truth is that for a large part of medical practice, we don’t know what works,” Welch wrote. “But we pay for it anyway.” Because of that, Welch advocates putting aside “questions about how can we do this better, faster or more consistently” in favor of “questions about whether the practices are warranted in the first place.”

No doubt, Peter Drucker would have agreed. “There is surely nothing quite so useless as doing with great efficiency what should not be done at all,” he famously wrote.

What often complicates things in medicine, Welch noted, is that while we should be rigorously evaluating standard practices to see what’s working and what’s not, “research is dominated by research on the new: new tests, new treatments, new disorders . . . new fads” and, above all, “new markets.”

But not everything new, as Drucker pointed out, is truly innovative. It’s a “trap,” Drucker warned in Management Challenges for the 21st Century, “to confuse ‘novelty’ with ‘innovation.’” He added: “The test of an innovation is that it creates value. A novelty only creates amusement” (though, admittedly, “amusement” is a funny word when it comes to, say, a newfangled colonoscopy.)

If something is worth making or doing, it must be provable. As Drucker wrote in Toward the Next Economics, “To produce results, it is necessary to know what results are desirable and determine whether the desired results are actually being achieved.”

Not that most of us are about to say that to our doctor.

Where do you think practice and results diverge most in medicine today?