Medicine or Finance?

[JMedical08]

Any trained monkey can read a lab chart. "if you don't know this...you need to do more research" lol that's all I'm doing right now. Actually I'm writing a thesis on this. "we are not optimizing our evidence base" pretty big words you got there. Maybe you need to do some research, here's just a few for you,

1. The diagnostic methods of ADD and ADHD, in America, Britain and France why is there such incredible discrepancy between them? How does "analytical" medicine, as you like to call it fit into all this?

2. The varied surgical practices of lumpectomy plus radiotherapy in Britain vs. radical mastectomy here in the States

4. American doctors use higher drug dosages than other european countries, even when recommendations drop, e.g. when the recommended dosage of anticoagulants was lowered, doctors still used the higher dosages, putting the patients in danger of bleeding

5. This one is from Medicine and Culture, "And when an (American) twelve-hospital study of the treatment of premature infants found that those at one hospital had been treated more gently and had fewer complications (interestingly, their treatment was supervised by a Chinese doctor) than those at the eleven other hospitals, the author of the study did not recommend that the gentler treatments be adopted nationwide but called for further research. Further research is always commendable, but one wonders whether it would be called for had the result shown more aggressive treatment was associated with a better outcome"

Your view of medicine being aggressive and optimized to the max on so called "evidence" is actually a well studied part of American medicine. I have nothing against mathematical models, or analytical based medicine, but in truth that is just a part of what medicine should really be about. There are no standardized measurements right now that compare international medical systems, which is a shame because some medical treatments and procedures in countries like, Germany, France, Britain have higher success rates. Medical practices that place more importance on the whole well being of a patient and not breaking down a human body into parts that can be separately treated and fixed.
Even with medical studies there are so many biases that go out into reports and get filtered out through drug companies. Think of all the drug recalls, think of all the contradicting studies. Type in "mechanisms of action drug unknown" into Google and realize that we don't know exactly how most drugs work.

It's not that we don't need more doctors who are analytical, but we need doctors who place importance on other aspects of the patient, analyzing not just diseases in terms of numbers, but more abstract thought patterns, like hypochondriac patients, cultural perceptions to diseases (ADHD, ADD) even simple colds, where patients go see the doctor expecting a prescription or their office visit wasn't worth the time spent, not realizing that your body can sometimes be the best defense mechanisms against minor colds and not heavy doses of antibiotics which can make colds worse for you and then next person you pass it on to. (antibiotics aren't proper treatments for a cold, yet so many patients still receive them, just an example of how something so basic in medical practice can't be solved just by being strictly "analytical")

First of all, don't use the number of mastectomies versus lumpectomies as a measure of quality, many women who know (told by their doctor) that survival is the same choose mastectomy. If you want people to be more sensitive to patients then you have to take into account patient preferences. Might want to think about this for your thesis. (Hint, look at medical centers that have high mastectomy to lumpectomy ratios for early stage breast cancer - they will not necessarily be the most aggressive cancer centers). People have tried to use this ratio as a measure of quality but I, along with man others, don't buy it.

Secondly, optimizing the evidence base does not mean being the most aggressive, optimizing the evidence base for an individual means taking into account his or her values, not values according to a "population mean." This is why it is important for every doctor to understand the policy models, if they did, then doctors could use the models and tailor them to the individual and thus optimize for that individual with his or her preferences and personalized risk, etc.

I think you would find we agree on most of these issues.

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[Zyvox]

First of all, don't use the number of mastectomies versus lumpectomies as a measure of quality, many women who know (told by their doctor) that survival is the same choose mastectomy. If you want people to be more sensitive to patients then you have to take into account patient preferences. Might want to think about this for your thesis. (Hint, look at medical centers that have high mastectomy to lumpectomy ratios for early stage breast cancer - they will not necessarily be the most aggressive cancer centers). People have tried to use this ratio as a measure of quality but I, along with man others, don't buy it.

Secondly, optimizing the evidence base does not mean being the most aggressive, optimizing the evidence base for an individual means taking into account his or her values, not values according to a "population mean." This is why it is important for every doctor to understand the policy models, if they did, then doctors could use the models and tailor them to the individual and thus optimize for that individual with his or her preferences and personalized risk, etc.

I think you would find we agree on most of these issues.

The mistake is comparing ourselves to ourselves, I'm talking about understanding ourselves in light of others. And of course it's important for doctors to understand policy models and optimize treatments and blah blah. Come on, how could any one disagree with that. But I think we can agree that the American medical system is not very open to the European medical system, and the two with collaboration could work much better together.

Say, why is low blood pressure considered a sign of health in the United States and sickness in Germany? Again these aren't just black and whites, and established policy models, the issues are entangled much deeper beneath than we realize.

 

[zogoto]

Thanks for all the replies. It seems a few people have said that I should go into finance because it looks like I can make more money there. However, keep in mind that I don't actually care that much about the money for myself. It's nice to have nice things, but 2 weeks after you buy a gigantic TV, you're used to it and don't really appreciate it anymore. That's just how humans are (probably for the better).

I understand that it seems bizarre logic to say "I'll go into this field (finance) even though it's not as fulfilling and doesn't help that many people day-to-day because in the end, I can donate $1 billion to charity and help more people than any doctor did." But is it wrong anywhere? Why doesn't that work?

People have said it sounds like I want to go into finance. That's probably because I'm playing devil's advocate here since most (or all) people here are pre-med. I am very interested in doing medicine and can really see myself doing it in the long run, but I feel that I have some responsibility to do the most amount of good possible, especially if I have the opportunities to do so right in front of me. If that entails me doing something I like a little less than medicine, but helps 10000 more people, isn't that worth it? I'm just one person, after all.