University Health Care - UHC and Intermountain Health Care are Off Track in Treatment Paradigms

The University Health Care at the University of Utah and Intermountain Health Care newly adopted model for data-driven medicine is swinging the pendulum too far in the wrong direction.
So called "facts" can be as elusive and foggy as the anecdotal and experiential "data" they reject out-of-hand.

It's a case of lies, damn lies and statistics. The IHC and UHC reliance on data-driven practice treats to the statistical spread and some patients get lost in the cracks of that spread.

Statistics get glossed over with weary eyes, and take on a life of lies. After the worn-out physician repeats the lie enough it takes on the look and character of a damn lie.

IHC's conceptual model is Dr. Demming the efficiency guru who taught the Japanese how to build cars after World War II.

But people aren't cars, and Demming is a wrong-headed model for medicine. Demming is a damning pariah of a paradigm for personal medical care. Where's the art, the hunch, the educated guess?

Is medicine so "scientific" now that it no longer needs its sister method of treatment - art?

Let's give an example.

I went in for acute sinusitus to the Redwood Clinic. The infection had persisted for several weeks and had gone into my chest. Three times I went in to to get antibiotic treatment for the infection and was denied by each doctor. Very ill and still languishing, I told one of them that they should be treating the patient, not the "statistical spread." But that was dismissed in an arrogant chuckle.

Finally, some months later, the last doctor explained that what they were doing was called research based medical practice. She was kind and informative in her exam table mannerm - which at least five other doctors weren't!

Still, I did not get any antibiotics. But since I was teaching high school biology, she suggested that I go into the research and read for myself what they were doing.

I did just that and stumbled onto a podcast from Britain's Lancet [March 14, 2008] that detailed how wrong they were in my particular case - how dogmatic they had been in applying this new-fangled "grand breakthrough" in medical practice.

Having read Thomas Kuhn's "Structure of Scientific Revolutions" I know this paradigm based on Demming's work is not the stuff of a scientific revolution! Neither is this a "new direction" in medicine. It's an old direction of science and math pushing out the human factor. Talk to Mary Shelly about that Frankensteinian direction.

The March 14, 2008 Lancet podcast (at about 2:50 remaining) is where they discuss the particulars of their review of more than a 1,000 studies. They conclude that, in a primary care setting, of 15 patients who receive antibiotics, only 1 gets an appreciable benefit from a course of antibiotic. That a person would receive any benefit from antibiotics is "relatively rare in primary care." - Lancet 2008; 371: 908-14 (Basel Institute for Clinical Epidemiology, University Hospital Basel, Switzerland [JYoung PhD, ProfHCBucher MD])



They did identify a subgroup with an infection that hung on for more than 4 weeks. But cautioned that those should have a culture done, but not with the limited resources of a primary care facility.

Then near the end of the podcast they stated that those who have the infection spread to the chest, seem to have an appreciable benefit from a course of antibiotics.

Utah reporter Chris Vanocur had the lead statistician and founder of this "movement" on Vanocur's weekly interview program this past week [December 22-23, praising data-driven practice as a "significant breakthrough" - and as pointing the way things will be in the future.

Vanocur almost gushed as he mentioned that this new school had been politically attacked by less enlightened doctors - apparently still practicing intuitional-voodoo medicine. Vanocur and his math-loving guest both chuckled at how backward these doctors must be. I could almost hear in their derisions the echos of a Star Trek episode. they sounded like two Vulcan know-it-alls pooh-poohing the human reliance on hunches when the going got rough.

It should do away with physician burnout, since it is less draining on the practicioner, avoiding the pitfalls of intuition and hunches. This new school of medicine ran their statistics and found that the doctors who relied on the phrase "in my experience" were wrong 95% of the time.

It almost sounded like a Brave New World [Aldous Huxley] in their reliance on science to answer all their questions, squeezing out any messy human interactions - so clinical and clean now.

What is dangerous about this kind of medicine - the Demming Paradigm of medicine - that relies on statistical generalities of passed-on, oral tellings of abstracts, rather than of specifics - of the concrete that is right in front of them sitting on the exam table - is it will cause not an insignificant amount of patient suffering in the name of efficiency - medical and political.

You can practice medicine "to the statistical spread" all you want, but when I get on the table in the exam room you sure as hell better treat me the individual, and get deeper into the studies as they apply to me.