tag:blogger.com,1999:blog-2308282620289958037.post7967728784954008375..comments2023-08-08T08:41:19.586-04:00Comments on The Medical Contrarian: Sound Bite MedicineThe Medical Contrarianhttp://www.blogger.com/profile/09240492315542223258noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-2308282620289958037.post-14404896002511316342011-03-02T18:13:52.043-05:002011-03-02T18:13:52.043-05:00Excellent post, however as a fellow disciple of Ri...Excellent post, however as a fellow disciple of Richard Epstein I would take issue with the concluding sentence. That patients "deserve" better is a value judgment more based on a deontological perspective than a utilitarian one. That they will "demand" better is good as competitive forces in health care as in any marketplace is welcome. However they will not get what they want from other quarters—they will get what they pay for. Given the present and prospective reimbursement structure, and the constraints legal and financial to circumventing it, patients will be getting soundbites for medical information from their physicians now and increasingly in the future—and probably mini-bites at that. And the quality of information they pay for from alternative sources will follow the fundamental axiom of "you get what you pay for" as well. Unfortunately in the professional realm there is an accelerating tendency of regression toward the mean—or perhaps in this case regression toward mediocrity—for care, especially the educational component of its patient encounters. The extrinsic pressures toward homogenization of care and the unthinking, reflexive practice of medicine that physicians in training learn ("get a PSA or mammogram" "that atypical looking mole there must come off because it is almost certainly a melanoma" as my pathologist will certify) will insure this trend continues until market forces are allowed to operate on economic side, legal and regulatory constraints are reigned in on the political one, and academic institutions reassert their primary mission of training practitioners to think critically.CAMnoreply@blogger.com