Bryan, thanks for this post. I’m near the end of my career as an internal medicine doctor (first few years) and an anesthesiologist (last three decades). Safety-ism does indeed pervade the profession. It’s a weird combination of paternalism, innumeracy, and some fear of malpractice litigation, though that’s more often used as a post-hoc …
Bryan, thanks for this post. I’m near the end of my career as an internal medicine doctor (first few years) and an anesthesiologist (last three decades). Safety-ism does indeed pervade the profession. It’s a weird combination of paternalism, innumeracy, and some fear of malpractice litigation, though that’s more often used as a post-hoc justification for lazy thinking and for the other silly things we do.
It’s odd; paternalism is officially “out“. We are these days supposed to offer patients our advice, and let them choose (which is often absurd, given the massive knowledge gap), yet we are still paternalistic about the least important stuff. And don’t forget that a number of our specialty societies (looking at you, pediatricians) have decided that their brief is social activism dressed up as “advocating for our patients”.
The massive knowledge gap should mean that patients have an ever greater need for a trusted intermediary. Yet we don’t seem to selecting for that characteristic.
And is it possible that the safetyism can be (at least partially) attributed to measuring “physician quality” based on population level outcomes vs the actual treatment of the actually presenting patient? With the vast majority of physicians being “employed” vs owners of their own practice - loyalty is at best divided between the employer (paycheck) and the patient (mannequin on which to employ “best practices”).
Bryan, thanks for this post. I’m near the end of my career as an internal medicine doctor (first few years) and an anesthesiologist (last three decades). Safety-ism does indeed pervade the profession. It’s a weird combination of paternalism, innumeracy, and some fear of malpractice litigation, though that’s more often used as a post-hoc justification for lazy thinking and for the other silly things we do.
It’s odd; paternalism is officially “out“. We are these days supposed to offer patients our advice, and let them choose (which is often absurd, given the massive knowledge gap), yet we are still paternalistic about the least important stuff. And don’t forget that a number of our specialty societies (looking at you, pediatricians) have decided that their brief is social activism dressed up as “advocating for our patients”.
The massive knowledge gap should mean that patients have an ever greater need for a trusted intermediary. Yet we don’t seem to selecting for that characteristic.
And is it possible that the safetyism can be (at least partially) attributed to measuring “physician quality” based on population level outcomes vs the actual treatment of the actually presenting patient? With the vast majority of physicians being “employed” vs owners of their own practice - loyalty is at best divided between the employer (paycheck) and the patient (mannequin on which to employ “best practices”).