A Prescription for Frustration

Abigail Zuger in The New York Times:

BookTime spent in hospitals brings out the inner Chekhov in some doctors, the inner Che in others. Then there are the occasional hybrids, the storytellers who secretly plot revolution and the revolutionaries who wind up telling fairy tales. One might argue that Dr. Leana Wen and Dr. Joshua Kosowsky belong to the latter group. At least, their impressive “When Doctors Don’t Listen” is a manifesto motivated by very active imaginations, not that this necessarily diminishes the book’s importance. The authors, both emergency room physicians at Brigham and Women’s Hospital in Boston, do a fine job of sorting through most of the serious problems in American medicine today, including the costs, overtesting, overprescribing, overlitigation and general depersonalization. All are caused at least in part, they argue, by the increasing use of algorithms in medical care. Algorithms are flow charts, created by groups ranging from individual hospitals to large professional organizations, dictating what tests doctors should order and what medications they should prescribe in hundreds of different situations. Deployed throughout medicine, the algorithms are perhaps used most frequently in emergency rooms, where any single word a patient utters may set off a long cascade of programmed activity.

…The book’s insights and cautionary tales should appeal to medical and lay readers alike: they combine into a superb analysis of how doctors listen and think, and offer detailed suggestions for how they could do both better. But when the authors embark on an earnest campaign for patients to grab the reins and steer their own wayward doctors gently but firmly onto the right path — there, I would argue, is where the fantasy begins. “Participate in your physical exam,” they urge their readers. “Make the differential diagnosis together.” A healthy person might take on that difficult assignment, especially the advice about learning how to tell an effective story (start at the beginning, don’t leave anything out, avoid technical terms). But most acutely ill people just want an experienced person to take over, to do what has to be done and do it fast.

More here.