Experts Blame Doctors

Experts often sound out of touch.

A well known doctor said,

“…and frankly, when they [patients] are admitted to hospital 4 and 5 and 6 times a year, often it’s because people like me aren’t doing a good enough job of keeping them out of hospital and managing their illness well in the community.”

~48:45 start Bending the Healthcare Cost Curve

That seems strong.

  • How often do patients suffer because docs aren’t doing a “good enough” job?
  • Should the CPSO punish doctors if patients end up in hospital?

Michael Decter thinks so. The former DM of Health in Ontario said this about diabetes care,

“There’s a standard of care here. If you meet it, there’s an incentive. But you can’t go on as a physician licensed by a college and not meet a professional standard of care. And I think in some cases, the profession has let itself off too easily on some of these things.

There is an acknowledged right way to treat and manage this disease and I think at some point the College of Physicians and Surgeons is gonna have to step up and say, Okay, ya know, malpractice isn’t just, ya know, taking off the wrong breast.

Malpractice is also not organizing your practice to support a patient with diabetes…but we shouldn’t be bashful about saying some things are unacceptable. And not tackling diabetes until it’s an amputation is not acceptable.”

~29:35 start

So there you have it.

  • Amputations are doctors’ fault.
  • Admissions to hospital are doctors’ fault.
  • We could “Bend the Healthcare Cost Curve” and healthcare would be great, if doctors would just do their jobs. QED.

Experts

Non-physicians, and many academic physicians, have never run an office outside of an academic centre. They are ignorant, in an academic sense. They are “lacking knowledge, awareness, or information about something in particular…” 

There is no harm when these experts share ideas with each other. But when they get positions of power, patients suffer.

Outside of data and statistics, medicine involves real patients who have a say in what happens to their bodies. Patients get to choose whether or not they:

  • Take their medications
  • Change their diet
  • Exercise

Doctors see diabetic patients for 20 minutes once every 3 months, if we can convince patients to come in that often. For 130,000 minutes until the next appointment, patients make choices. As they should.

It is absurd to blame doctors for everything that happens in a patient’s life based on a doctor’s input into 0.015% of it. Even enthusiastic, keen, self-motivated patients can end up with poorly controlled diabetes. Some patients need amputations. Blaming doctors and patients shows ignorance to real life patient care and a profound insensitivity to what patients manage in their lives, besides their diabetes.

Experts see poor outcomes and assume doctors do not care. Doctors must be slacking off. Doctors did not explain diabetes clearly enough, or with enough detail. Doctors are the focus and the problem.

Focus on Patients

We must build a system around patients. We must start with their needs. We should support and serve them.

We should not incentive doctors for twisting the arms of patients to achieve ends that experts have decided are good.

  • What if a patient does not want to visit his doctor for his diabetes every 3 months?
  • What if a patient gets tired of 10, 20 or 30 minute visits about diabetes four times a year?

Great docs serve and partner with patients, no matter where patients may be on their life journey.

Doctors are incredibly motivated, driven even. If medicine was only about data and results, then doctors would care most about them. 

Maybe a single Mom with two special needs kids has to focus on other things besides her Hb A1c. Mom might have her hands full worrying about  her kids arriving home alive. Her doctor should support Mom where she’s at, not badger her about lab values. Hopefully the lab values will improve later. But some never do.

Experts do not get that. They blame doctors instead.

36 thoughts on “Experts Blame Doctors”

  1. Michael Decter knows nothing about healthcare besides what he learned when parachuted into the MOH as a naive manager. He has no medical training and has only viewed the healthcare system through the twisted lens of the country’s most overgorged bureaucracy. It is ludicrous that anybody pays any attention to what he says. After leaving MOH he is trying to make a living being a so called expert screaming against anything and everybody and giving TV interviews and writing specious books.

    1. Strong words, but I expected people would feel this way. I had to really tone down my first few drafts.

      The most frustrating part is that his comments shape the environment in which we work. If he says that on National TV, I wonder what he says about doctors when the camera is off.

      Thanks Ernest!

  3. Is that the same Michael Decter who starts ever talk/presentation with “My father was a physician and I have tremendous respect for physicians”. He then goes on to weave a tale of half truths and misrepresentations of the facts that slam docs.
    Could he be the ADM under the Bob Rae government whole heartedly endorsed the Barer Stoddart report which was fundamentally flawed and resulted in significant physician shortages and long wait times. Does anyone remember his expense account for meals etc during the Social Contract and moving expenses claimed that were reported at over $100,000, as he left his position shortly after the Shelley Martel affair where she slandered a physician at a cocktail party disclosing his exact billings? I believe her defence, in an inquiry that cost us all $400K, was that she was lying and just made up the number.

      1. You don’t seem old enough to know that Decter was Ontario Deputy Health Minister when Barer Stoddard report was used to decrease the number of medical school places in Canada to save governments money. Years later, Decter was hired by Federal Government to look into and address the shortage of physicians in Canada.

  4. Sewell latest book ‘ Intellectuals and society’ touches on it…” many of the disasters of our time have been committed by experts”…he defines “ experts “ as those whose end products are ideas as opposed to those who create actual end products….if a very intelligent engineer has a brilliant architectural idea and the building he builds collapses ( much like that brilliant piece of engineering that built that fantastic futuristic ex bridge in Genoa, Italy) …he or she is ruined.

    Not so , intellectuals whose brilliant ideas to rearrange society end up in disaster …they pay no price at all.

    “ The fatal misstep of intellectuals is assuming that superior ability in a particular realm can be generalized to superior wisdom or morality overall”….in fact, when an intellectual steps outside his/ her level of speciality, outside his or her’s realm, it’s much like them stepping off a cliff.

    Decter, as an “ expert intellectual” manufacturing ideas outside his realm of as in the field of health care has already inflicted enough damage, it is bizarre that anyone gives any weight at all to his latest bright health care ideas when they observe the debris of his previous ideas behind him.

    In fact the whole health care system that we are presently functioning within was built on the brilliant ideas generated by high IQ intellectuals working well outside their realms…they have paid no price at all for the disastrous dysfunctional tottering monopolistic monopsonic Canadian/ Ontario that they inspired…instead of being tarred and feathered they have been honoured and promoted…the universal scapegoat for all of the problems in the health care system is, of course, the innocents, the medical profession….each time matters go awry in the health care field…the punishing hob nailed boot goes into the gut of the medical profession, in particular, those at the grass roots and coal face.

      1. Thanks Andris. I love Sowell and enjoyed his Intellectuals book. I’m glad you made the connection here. It’s a perfect example of what Sowell describes.

  5. Thanks Shawn, but not far enough.

    It seems conflict is birthed in ignorance (not knowing), being an idiot (not understanding what you know) or worse in wanting to do harm to those who disagree (not trying to make things better). At least that is my experience.

    There is a polarizing trend to blame others, on the other side of disagreements, projecting they are ignorant, idiots or just plain mean spirited. That doesn’t hold much weight.

    It begs a greater question, what is a better way to communicate?

    I think you are right to label the issue, but I would be more overt about the character flaws that seed these bad arguments. Unfortunately few are listening to doctors now and that is a problem the OMA and leaders need to address urgently.

    Maybe ignorant and idiotic arguments need to be overtly labeled as such.

    Mr. Decter’s arguments reveal his ignorance of the issues at hand. . . His blaming doctors generally for unfortunate patient outcomes specifically is idiotic. The facts are available to him but he is so busy invalidating and intimidating the people doing the work, that he doesn’t see the whole picture.

    This is a chronic problem as his role does not require him to be educated in broad views, and he is not. The deputy minister is not required to be logical in practical manners, and he is not. His role is to be fiscally responsible while remaining impervious to the suffering he causes. That is exactly what he is doing.

    I encourage our leadership to be more overt, more logical, and quickly call out ignorance, idiocy and malevolence when they see it.

    1. Socrates and Confucius taught that the wise are aware of their own ignorance….so many of the intellectual “ experts” peddling their “brilliant” ideas to the various provincial and Federal ministries, the health ministriesfor example, end up, despite their high IQ’s , as incompetents, because they were completely unaware , ignorant, of their own ignorance.

      Then there is willful ignorance…which is, I suspect, a far more common phenomenon in the ranks of the so called “ experts”.

      1. Good comments, Barry, and response, Andris.

        I toned down my original drafts. I worried about attributing maleficence if ignorance would explain things well enough. But your point about tackling these issues head on, Barry, is well taken.

        Thanks for taking time to post comments!

  6. That’s like blaming an addiction specialist when a patient overdoses on street fentanyl … it’s ridiculous and amoral. And what does this tool know about standards of care when he isn’t even an MD.

    1. Agree. Frustrating indeed. Same goes for parents who refuse immunizations, teens who won’t take their diabetes meds, and on and on.

  8. The idea that doctors are at fault for bad outcomes is in keeping with the views of those seeking to advance their political careers in Canada. Politicians score easy points by blaming the failures of our healthcare system on doctors. There is nothing in this argument to suggest that patients have to take some responsibility for their health, and that their choices (not necessarily bad ones) directly affect health outcomes.

    Shawn, I like how you dealt with this issue in a sensitive way. You make the point that patients are not necessarily responsible by being noncompliant, but often by virtue of the fact that they have to make hard choices. If a diabetic single parent is trying to raise two kids, or worried that they’ll lose their job by going to doctor appointments, they may decide that they just can’t follow care plans in a way that they might want to.

    While “experts” gain political capital by insulting physicians, it is the patients who suffer most. By saying that a failure to meet some “standard of care” metric is the fault of the doctor, they’re defining a standard of care that even the most well-meaning of patients may not be able to meet.

    If I’m a diabetic who doesn’t meet the magic HgbA1c target, because I’m afraid I’ll lose my job if I take time off to see the diabetes educator, or because my disease is treatment resistant despite my best efforts, how would that make me feel? I might feel like a failure, or a bad person.

    These “targets” defined by “experts” imply that perfection in the management of chronic disease is possible, and that failure to achieve these targets is the doctor’s fault. As a well-meaning patient, they also imply indirectly that failure to meet perfection must be my fault.

    Successful chronic disease management is too complicated to attribute to meeting certain targets. I’m not surprised that a non-physician like Mr. Decter might not appreciate that, but disappointed that Dr. Martin, a physician, gives the appearance of not understanding that either.

    1. Thanks for sharing such a thoughtful comment, Coryn. It appears that you watched the video — excellent. It really helps to see and hear the whole thing to get a better sense of the feeling that comes through.

      I like how you’ve highlighted the stress that patients feel. Job loss certainly ranks higher than Hb A1c if you are feeling otherwise well.

      I sure appreciate you reading and taking time to share!

      Cheers

  9. A few years ago, Alberta Health Services tried to set up a diabetic patient registry. The Primary Care Networks in Edmonton were charged with identifying all the diabetics and collecting numbers on all of them: BP, weight, A1c. Our primary care nurses became data entry people and spent 1+ hours daily doing this work rather than actually dealing with patients. The project failed. Obviously driven by the perceived need for numbers and QI. An attempt to measure what we manage. It doesn’t at all mean we can manage what we measure.

    1. Brilliant story, Denis. Thanks for sharing it. I often wonder whether some folks will never understand how this all works until they do it themselves…which will never happen.

      Thanks again!

  10. Shawn, provocative and polite per usual. (Clearly I need to consider another p-word in that sentence.)

    I realize there are serious issues here but I can’t help but focus on one key question: Is that Decter’s real hair?

    Intrigued.

  11. Wow… there is so much wrong about that idea that I just don’t know where to start. Thankfully, most of my thoughts have already been expressed above.

    Yes, there may be some physician inertia, especially with targets only slightly abnormal… but a lot of that is from some bargaining and negotiation with the patient – “doc, just give me 3 more months before we start with insulin… i can get the weight off…”

    Where is the patient accountability in all of this. We set up a treatment plan and if the pt doesn’t follow it, why is that not on them ? Weight going up… snacking on the wrong foods… I’m not there watching what goes in their mouths, so why is that on me ?

    Let me do a physician satisfaction survey on the patient. Did I find the encounter pleasant ? Were my needs met ? Did the patient fulfil my goals ? All those pt’s with an unsatisfactory survey need to shape up or be dropped from the practice. I think I should start a ratePT.com site. Orphaned pt ?? Let me look them up… oh, oh.. Poor rating – poor communication, noncompliant and argumentative.. I don’t think I want to take them on.. 1/5 stars..

    Need to chk this out on GoDaddy… will let you all know when its up and running!!

    1. Very creative…it would be public relations suicide…about as bad as Decter’s comments…but I guess that’s your point!

      I’m reading a great book now called, Seeing Like a State. The state always wants to simplify and measure. Real life is complex and confusing, not amenable to measurement and taxation. Looked at through this lens, Medicare has been a 50 yr experiment in trying to fit clinical care into simplified, standardized administrative units. But patients do not fit.

      Thanks again for posting! Always thought provoking.

      Cheers

      1. Shawn – so you feel rating pt’s is like doing PR seppuku… I guess that means pts are simply the USERS of physicians and its a one way flow. But noncompliance, etc is part of pt accountability, is it not ? So by extension, are you saying that trying to get some pt accountability is unobtainable ?

        We know politicians hate pt accountability because that puts voters in direct opposition to political policy… But has anyone done any studies that look at the cost of pt accountability to the system. (other that the study above – we can extrapolate that to the cost of healthcare across all docs in Ontario).

        1. I love your line of thinking here, Rob. I agree, pt accountability must be addressed. I liked your seppuku analogy regarding the first proposal. 🙂

          But that doesn’t mean the system shouldn’t discuss the issue more broadly, as you say, and come up with specific ways to address the other end of the doctor-patient equation. I say ‘the system’ with intention. I do not think that doctors should be the ones pushing for patient accountability. If politicians truly worry about costs, then they should look at all factors, not just those that they deem politically safe.

          Returning to you original comment about USERS. There is some truth in there. It is an axiom of exchange: Providers always attend to the payer or regulator no matter who it happens to be. In second and third party payer systems, the first party – the patient – gets a different kind of attention than in 1st party payer systems. Furthermore, in 3rd party, first dollar coverage systems, you get the worst of all worlds. Attention gets drawn away from the payer and the patient sees the provider as a roadblock to all they are entitled to receive. It becomes an acid that eats through the doctor patient relationship.

          Great comments! Thanks so much for taking time to share more.

          Cheers

      2. Is there anything so wrong about a ratept.com site though???
        We need to have the conversations
        A patient I have been seeing for years, who I have seen though manic episodes, major slips in sobriety…, today jokingly ( it seemed) threatened to register a college complaint if I did not give him another carry for his methadone..,..
        I took the opportunity to advise him that he was on the verge of dismissing me as his physician….he was shocked
        We need to make patients own up to their actions…..,, we have feelings, reputations and expectations as well
        We need to expect and demand mutual respect

        1. Solid points, Debbie!

          I got chest tightness reading your methadone story. I have only ever had threats around narcotic issues, too. Respect has to run both ways for sure. Tough conversation…might be a good topic for a policy afternoon. I’ll mention it.

          Thanks again for reading and posting a comment!

          Cheers

    2. Shawn, it seems you are giving them the benefit of the doubt by calling them ignorant instead of evil. 😊

    3. This is from a collection of stories about patients. You can’t make these up.

      COLLEGE OF PATIENTS

      When I was in the hospital having surgery many years ago, a lady complained to my receptionist: “But I have an appointment!”
      —-
      Another lady once said, “Who is more important, me or your son?”

      —
      was in hospital for 5 days…when I missed my clinic days, the nurse told pts. sorry Dr. Lxxxx is sick, pt said “tell her to take some Advil and get her ass to work”…not kidding.

      1. Wow. Were these people cognitively intact? As in, should we be able to expect better of them? Some people say odd things about everything all the time…

  12. As an aside to this Clown of the Public Trough’s comments….the use of, from thousands of other choices, the imagery of a doctor cutting off a breast, let alone the wrong one, was astoundingly ignorant, viscious, mysoginist in its accusation, and inflammatory, amongst many other insult types. With diabetes complications being rampant, it even hints , if even subliminally, that doctors are routinely chopping (deliberate imagery here provoked by him) off the wrong breast quite commonly, being a bar that diabetes complications reach just as high for, don’t you know, you plebs! I did a double take when i saw that…why not other common malpractice examples, like removing the wrong testicle, or slipping with the scalpel and “removing the entire penis”, you know , a common error like lazy and complacent breast removal errors. He should be fired on the spot for that alone. Shawn is to kind and political to call him what he is…a fat rich white wigged male pseudoexpert living on a sweet pension paid for by taxpayers…the real question he should have been asked is: “Sir, you appear to have a BMI of Jowals-defcon Red…have you, by your own argument, commenced with a malpractice suit against your own doctor, given his clear failings, ne sheer neglect and malpractice, at preventing you from going to the Old Rich Bastards Club to feed at the scotch and gravy trough? Your Jaba the Hut persona suggests your doctor has failed you entirely!”

    1. Hey Ksy11

      Yikes. I’m a fierce believer in free speech. So, I take your comments as a piece of literary jeremiad, more lament with poetic zing designed to make a point. I only say this in case someone tries to take what you said as literal. You cannot be too careful these days.

      I hope people can see that your comments are meant to exaggerate in order to spark discussion.

      Thanks for taking time to read and post!

      Cheers

  13. Pingback: Should Doctors be More Accountable? - shawn whatley md

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