I have this same conversation with my non-healthcare friends almost yearly. You touched on everything I saw, but I'm not sure I understand what you mean by:
> Reported outcomes are often erroneous or frankly fraudulent
Could you elaborate?
> Reported outcomes are often erroneous or frankly fraudulent
Could you elaborate?
- History and physical exam are extremely subjective.
- Medical notes and records can be massaged to sound better than reality (The patient didn't have a stroke after their operation. They had "minor lower limb weakness which we anticipate will improve over the next few weeks") or attributed to all sorts of things (patient's cognitive function hasn't worsened, they have some "fatigue" following surgery).
- People can be very selective about which studies are ordered.
- Junior and ancillary staff are reluctant to report poor outcomes about established senior people.
I'll give a real-life example: Professor X is a "world-renowned expert" on neurosurgery at an academic mecca. He claims a "1-2%" complication rate on aneurysm surgeries in the clinic and at any conferences. His residents know he performs outdated surgeries with spectacularly bad outcomes but no one would be willing to talk about this openly unless they want to torpedo their career prospects.
Someone close to me, a very experienced nurse, reported some misconduct on the part of a senior physician. This was both required by law and an ethical duty.
She essentially got blackballed from that hospital as a result.
And before you judge anyone too harshly, talk to me again when you have 300k of debt and you're a fourth year resident stuck in a singularly focused career pathway.
Also, the reality is most people have so much else going on to concern themselves with that these things are given little thought.
Accumulation of power inevitably leads to abuses of said power, at least in my experience.