Friday 27 July 2012

Healthcare isn't about health

Robin Hanson likes to point out how healthcare isn't about health, it's about showing we care. People spend stupid money on known-to-be-worthless treatments to show that they care about the person being treated and choose doctors based on bedside manner rather than success rates. Some will even torture loved ones with useless treatments to convince themselves of how caring they are.

When we were choosing an obstetrician, it was hard to get recommendations about who was effective rather than who was nice: I blame all of you who care more about bedside manner rather than results. You are the problem.

Today's evidence: doctors are more likely to be thrown out of the business for having sex with patients than for killing patients.
Doctors are more likely to be struck off for having sex with patients than for misdiagnosing, breaching patient confidentiality, or performing the wrong operations, a new study shows.
The research on doctor misconduct in Australia and New Zealand found medical tribunals removed or deregistered doctors for character flaws and lack of insight more often than for errors in care or poor clinical knowledge.
Researchers from Melbourne University expected to find zero tolerance for sexual relationships with patients, but found it was unclear why having sex with a patient was much more strongly linked with removal than other forms of sexual misconduct.
There are a lot of small towns in New Zealand and Australia where a single young doctor would have a hard time not dating a patient.
Researchers analysed 485 professional misconduct cases over 10 years from New Zealand, Victoria, New South Wales, Queensland and Western Australia in which doctors were found guilty.
Of the 79 cases in which doctors were guilty of a sexual relationship with a patient, 64 were removed from practice, according to the study published this week in the British Medical Journal.
Although it was far more common for doctors to be found guilty of inappropriate or inadequate treatment, writing inappropriate medical certificates and records, and illegal and unethical prescribing, they were much less likely to be removed for such offences.
One reason could be that "dysfunctional behaviours and clear signs of bad character may be perceived as relatively untreatable", while a lack of knowledge or problems in the work environment might seem easier to correct.
If healthcare were about health, it's hard to imagine this being the equilibrium.


  1. I suspect a lot of people don't see their GP/family doctor as a means to increasing "health" outcomes as increasing "well-being" outcomes, in which being treated nicely by a doctor is part of the well-being.

    Life-and-death and serious stuff are (in people's minds) left to hospitals, hence we cheer for Dr. House but we don't want to have him for our GP.

  2. Agreed that bizarre-but-widely-held consumer preferences of this sort make it harder for the folks like me.

  3. I whole heartily agree, I have been prevented from practicing because of my bipolar disorder on the premise that I 'might harm a patient' despite having no complaints against me in 15 years of practice. I have witnessed on numerous occasions patients actually being harmed by poor performing doctors but they get away with it.