It has taken me awhile to get to this article by Hartzband and Groopman, "Rise of the Medical Expertocracy," from the March 31, 2011 Wall Street Journal. If you happened to miss it, it is quite thought-provoking.
Whether you are coming from the left or right perspective on health care reform, there is an underlying singular assumption that there is a "best practices" or "evidence-based solution for every difficult problem in medicine and health care delivery. This may be naive wishful thinking or a zealous belief in the power of science, but, either way, this assumption is pervasive amongst physicians, "experts" in various medical disciplines, as well as politicians and policymakers. I aver that this is a pernicious and dangerous assumption for both medical practice and health care policy.
One interesting part of this article is the authors' discussion of the results of their study interviewing how patients process and act upon "expert" advice and information. Perhaps not surprisingly, there is indeed a wide range of how patients make medical decisions--which is also reflected in the range in how members of expert "consensus" panels also view the same evidence and arrive at different, indeed, opposite conclusions.
The authors' observation of the rise of the industry supplying metrics and report cards to doctors, health plans and hospitals is particularly insightful--and disturbing. How much of the health care dollar goes to companies measuring and benchmarking health care hospitals' own data? I know my hospital spends a lot--as well as spending on how to remediate or improve to get where the experts say we need to be in the 90th percentile. To me, this seems to stifle the trial-and-error, locally-based approach that might truly provide innovation that could be appropriated or adopted elsewhere.
I will confess an inherent skepticism and distrust of experts (especially those panels that are buddy-appointed), but the authors make what should be obvious points:
For patients and experts alike, there is a subjective core to every medical decision. The truth is that, despite many advances, much of medicine still exists in a gray zone where there is not one right answer. . .Patients and doctors can differ with experts and not be ignorant or irrational. Policy makers need to abandon the idea that experts know what is best. In medical care, the "right" clinical decisions turn out to be those that are based on a patient's goals and values.