Healthcare: Getting Armed with Information

The plain fact is that many clinical decisions made by physicians appear to be arbitrary, uncertain and variable. Reams of research point to the same finding: physicians looking at the same thing will disagree with each other, or even with themselves, from 10 percent to 50 percent of the time during virtually every aspect of the medical-care process—from taking a medical history to doing a physical examination, reading a laboratory test, performing a pathological diagnosis and recommending a treatment. Physician judgment is highly variable.

Why are so many physicians making inaccurate decisions in their medical practices? It is not because physicians lack competence, sincerity or diligence, but because they must make decisions about tremendously complex problems with very little solid evidence available to back them up. Cost is another toxic by-product of care delivery practices that are not based on solid science and the tremendous clinical variation that results from them.

The lesson here is that there are huge gaps in the scientific evidence guiding physician decision-making, and it wasn't until healthcare-quality gadflies like David Eddy began to demand to see the evidence that we learned about those gaps. This revelation has had at least two beneficial effects: it informs us about the lack of evidence so that we can be more realistic in our expectations and more aware of the uncertainty in medical decision-making, and it exhorts the medical community to search for better evidence.