A Humble Suggestion for the Overhaul of American Healthcare
The impetus for overhauling American healthcare might appear unexpected, stemming from a suburban pediatrician’s clinic, where a kindly physician advised my teenage son to sleep until noon. The justification was rooted in a singular study claiming that night owls exhibit greater intelligence. This incident underscores a more significant concern: medicine, usually based on empirical evidence, can be influenced by uncritical acceptance of research with dubious validity.
The issue reaches beyond this case. Some doctors adopt new medications based on initial studies revealing potential advantages, yet ignore larger, more exhaustive studies suggesting ineffectiveness or risks. Likewise, some practitioners endorse prostate-specific antigen testing without considering biases such as lead-time or overdiagnosis, frequently transforming healthy individuals into unjustifiably anxious patients. Additionally, misinterpretations of test outcomes and misconceptions regarding diagnostic logic, like misinterpreting a low-risk 20-year-old’s positive D-dimer test as definitive evidence of a condition, expose deficiencies in basic medical education.
The medical field often displays misguided priorities, emphasizing relative risk reduction over absolute risk reduction, resulting in distorted views of treatment efficacy. The preventative use of broad-spectrum antibiotics against viral infections, ignoring the reality of antimicrobial resistance, is a frequent misstep. Misunderstanding associations, such as low vitamin D levels coinciding with illnesses leading to unnecessary supplementation, exposes renewed logical fallacies in contemporary medicine. Regression to the mean is mistakenly celebrated as therapeutic achievement, and surrogate endpoints are eagerly pursued despite evidence indicating no effect on mortality or patient distress.
These are not simple oversights; they indicate a more profound intellectual shortcoming. Nevertheless, the educational journey to medical school remains unchanged, concentrating on subjects like organic chemistry and memorizing metabolic processes, which do not prepare future physicians to address these cognitive challenges. Aspiring physicians become versed in anatomical terminology but lack training in essential skills like critical inquiry or probabilistic reasoning.
The answer is clear-cut. Pre-medical education needs to incorporate, alongside fundamental sciences, courses that enhance critical thinking: multiple classes in probability and statistics, a full calculus track, and courses in research techniques. The goal is to cultivate an analytical perspective: skeptical yet receptive, precise but not overly meticulous, capable of differentiating between what is plausible and what is substantiated.
As Edmund Burke remarked, the “age of chivalry” has been supplanted by “sophists, economists, and calculators.” In medicine, the era of the reflective thinker has not yet arrived. Until then, the emphasis tends to be on treating numbers rather than patients, seeking correlations instead of causes, and pursuing sensational headlines rather than depending on established evidence. The healing profession deserves more, as do those who entrust their lives to physicians.
The author is an unnamed physician.