Dr. Eddy is prominently featured in chapter 1 of the book 'Demand Better: How to Revive our Broken Healthcare System' ...
Questioning the unquestionable
The problem is that physicians don't know what they're doing. That is how David Eddy, MD, PhD, a healthcare economist and senior advisor for health policy and management for Kaiser Permanente, put the problem in a Business Week cover story about how much of healthcare delivery is not based on science.
Plenty of proof backs up Eddy's glib-sounding remark.
The plain fact is that many clinical decisions made by physicians appear to be arbitrary, uncertain and variable.
Reams of research point to the same finding: physicians looking at the same thing will disagree with each other, or even with themselves, from 10 percent to 50 percent of the time during virtually every aspect of the medical-care process -- from taking a medical history to doing a physical examination, reading a laboratory test, performing a pathological diagnosis and recommending a treatment.
Physician judgment is highly variable.
Here is what Eddy has found in his research.
Give a group of cardiologists high-quality coronary angiograms (a type of radiograph or x-ray) of typical patients and they will disagree about the diagnosis for about half of the patients.
They will disagree with themselves on two successive readings of the same angiograms up to one-third of the time.
Ask a group of experts to estimate the effect of colon-cancer screening on colon-cancer mortality and answers will range from five percent to 95 percent.
Ask fifty cardiovascular surgeons to estimate the probabilities of various risks associated with xenografts (animal-tissue transplant) versus mechanical heart valves and you'll get answers to the same question ranging from zero percent to about 50 percent.
(Ask about the 10-year probability of valve failure with xenografts and you'll get a range of three percent to 95 percent.)
Give surgeons a written description of a surgical problem, and half of the group will recommend surgery, while the other half will not.
Survey them again two years later and as many as 40 percent of the same surgeons will disagree with their previous opinions and change their recommendations.
Research studies back up all of these findings, according to Eddy.
Because physician judgment varies so widely, so do treatment decisions; the same patient can go to different physicians, be told different things and receive different care.
When so many physicians have such different beliefs and are doing such different things, it is impossible for every physician to be correct.
... consider deep-vein-thrombosis (DVT) prophylaxis, that means therapy to prevent dangerous blood clots in vessels before and after operations in the hospital.
Research offers solid, Grade-A evidence about how to prevent DVT in the hospital.
But only half of America's hospitals follow these practices. That begs an important question: Why?
We have the science for that particular sliver of care. How come we still can't get it right?
I've posted this excerpt numerous times.