TRENDS
Breaking the Rules of Healthcare: Following the Science Why today’s doctors will provide the best care by following the science – and listening to patients. By Dr. Robert Pearl
American doctors today are the beneficiaries of
remarkable medical progress, driven by decades of worldleading research and computerized data analytics. Thanks to these advancements, physicians can avail themselves of scientifically proven and optimized approaches for 95% of medical problems. When followed rigorously, these approaches give doctors the best chance at successfully solving a patient’s problem. This is referred to in healthcare as evidence-based medicine. Research has shown that if every physician followed these algorithmic, science-based protocols every time, Americans would live healthier, longer lives and experience fewer complications from both acute and chronic disease.
Yet, all too often, doctors dismiss the data, preferring an outdated and unreliable approach to medical decisionmaking. This article, the fifth in a series called “Breaking the Rules of Healthcare,” explores an unwritten rule, which doctors have followed for centuries.
prevent and treat most life-threatening diseases. Because of this, they had little choice but to rely on their medical instincts and previous experiences when providing care. Doctors today still proudly listen to their hearts and insist on following their guts, trusting that – despite the data – their intuition will produce the best results. More often than not, that old assumption is proven wrong. The field of behavioral economics proves just how flawed human decision-making can be. Let’s look at an example from the criminal justice system. Evidence-based sentencing (like evidence-based medicine) helps reduce the negative impact of human bias. Though EBS guidelines are not perfect, they lead to decreased recidivism, increased public safety and improved rehabilitation efforts. But despite the data, most judges continue to believe their individual judgement is superior. In contrast to what people in dozens of disciplines think, a Nobel Prize-winning psychologist and economist Daniel Kahneman found that experts are not immune to “the influence of extraneous irrelevant information.” In fact, a series of studies about the judicial system found that when judges had the freedom to follow their “gut,” the harshness of sentencing varied wildly from judge to judge. Not only that, but prison sentences also were swayed by illogical variables, including the time of day and the weather. Judges handed down worse penalties for defendants right before lunch (and lighter sentences after their bellies were full). Likewise, rainy days led to worse punishments than sunny days. Intuition isn’t always wrong, but it’s rarely a better substitute for science.
When doctors overvalue intuition Rule No. 5: Doctors provide the best care by following their intuition For most of medical history, including much of the 20th century, doctors lacked the scientific knowhow needed to 48
June 2022
•
www.repertoiremag.com
Doctors routinely misjudge the accuracy of their instincts and the relevance of past experiences with patients. These flaws in judgement lead to deficiencies in clinical quality and inconsistencies in treatment.
