The Top 10 Medical Practice Myths

One almost laughable example of a myth that permeates administrative types particularly is, "Once we have computerized medical practices, paper will disappear." See, you are smiling already.

The basic idea behind science, medicine’s professed raison d’etre, is that we test ideas to see if there is rational, replicable evidence upon which we can base our treatments to help people. Myths are often stubborn social beliefs that do not have such backing and often persist in spite of good evidence to the contrary. Or sometimes they are half-truths, as if we were eavesdropping on a conversation, heard just a fragment of it, yet made assertive conclusions from that small bit.

Medicine is no exception to this human tendency, both for docs and for civilians. One almost laughable example of a myth that permeates administrative types particularly is, “Once we have computerized medical practices, paper will disappear.” See, you are smiling already.

Another that will produce a groan, at least, is that “Doctors are rich.” Yes, some are, like in any other field of endeavor, but being a hard-working, debt-carrying, managed care-afflicted, middle-class professional hardly qualifies. Perhaps the myth persists because there are so many of us spread all over and in daily, direct contact with all levels of society that the less affluent can see some external trappings. Expensive cars are usually the item most cited. My Silicon Valley friends certainly don’t think doctors are rich. Au contraire.

The third myth to put into the light of day is that doctors don’t get sick. And if we do, we are somehow seen as hypocritically not taking our own advice (myth four). The first charge is ridiculous, some studies show we might live slightly shorter lives, on average. But the second claim, sadly has some merit. I personally have known a pulmonologist who smoked and a weight control specialist who weighed over 300 pounds, for instance.

Number 5 is the corollary to number 3; doctors get better medical care than civilians. According to a many-year, unscientific survey of doctors and their wives that I know, docs and their families often claim to get substandard care. I have personally heard other docs say things to docs and wives like “You know what to do. Why are you here?”

Yes, some docs may play off medical folks’ foolish tendency to diagnose and treat ourselves. And some docs get nervous in front of other docs, feeling that they are being judged. Some truth in that, so the best have the ego strength to get past those fears

What docs do have better than civilians is faster and easier access. Of course, being a “work-in” is not usually associated with either adequate time or the attendant good attitude that can yield a positive outcome.

Moving on to number 6, docs will usually claim, sometimes a bit too loudly, that they are not influenced by drug reps’ blandishments. “I objectively do what’s best for my patient.” Sorry to disillusion you, but the drug companies have thorough, compelling, and ongoing evidence to the contrary. They pay for regular reports from local pharmacies that detail who is prescribing what and these do correlate with drug rep visits. That’s why there are tens of thousands of them. Meals, junkets, consulting fees, small gifts, etc. of course have nothing to do with being incentivized to change our prescribing….

Number 7 is that the cost of defensive medicine is a big chunk of the high cost of medical care. Many studies have looked at this idea and the consensus is that defensive medicine does exist, but it actually is a single-digit percentage of the cost of medicine.

What is lately getting more examination is the assertion by some academics that “defensive medicine” is really an unconscious, or conscious, cover for self-aggrandizing over-prescribing. We all have seen the headlines, some coming from the Dartmouth Medical School studies, for instance, showing that docs who own x-ray, lab, physical therapy, and so on simply order these functions significantly more than docs who do not own them. The Stark Rule against self-dealing notwithstanding.

The eighth myth, related to #7, is that docs are getting killed by frivolous lawsuits, high malpractice premiums, and big awards. Lawyers claim that 80% of claims are rejected by them and only 3% actually lead to a suit. Most do not go to trial and of those that do, the plaintiffs win only 21%, down from 26% a decade ago.

Also, premiums have been in a decade-long slide. Insurance does remain high for a few specialties in a few areas. But the recession showed that premiums have as much to do with market returns as with payments alone. Premiums and litigation combined are but a single digit percentage of the pie, although the pie is huge.

I know that this list is only 8 myths, not 10. So sue me.