Friday, March 3, 2017

Medicine and Pornography

Twenty years ago my back began hurting. After a week of hobbling, I went to a doctor who ordered an X-ray that showed “arthritis.” He injected something into the area. I didn’t notice an improvement, but after a few weeks the pain disappeared. Almost all low back pain goes away.

I had received what medical experts calls a “low value service.” You would call it a “useless test.” Good studies show that if you have acute back pain alone (without another symptom such as fever or a neurological defect) X-rays rarely help, and that includes super-X-rays such as CT scans or MRIs.

For years the medical establishment has been waging a campaign called “Choosing Wisely.”  It’s an admirable effort to persuade doctors (tactfully, no pressure…..) to stop ordering worthless tests, performing procedures that don’t help, or prescribing useless antibiotics. You can Google it.

Is it working?... Maybe a little. For decades journals have published studies in which a medical group tries to encourage its doctors to practice better medicine. Sometimes these programs flop. Sometimes they succeed but never dramatically. Unless it’s unpleasant (like a colonoscopy) patients like doctors to do stuff. Doctors themselves like to take action even if they know (they usually know) that it probably won’t work.

It’s like watching pornography. Most doctors feel a twinge of shame after they do something that’s not likely to help. They don’t disagree with experts who disapprove. But when a patient walks in, and they feel the itch…..

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