Medicine's Dirty Secret

Pete Ross

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Photo by Olga Guryanova on Unsplash

When we think of doctors, we regard them with only slightly less awe than astronauts. After all, these people spend almost a decade just learning how to be a doctor. They work insane hours and are always the best and brightest. These people cut patients open — I mean, just think about the confidence, intelligence and experience you need to do that.

Now think of a specialist. Cardiologist, neurosurgeon, orthopedics, these people are like the varsity team of medicine. If someone tells you at a party that they’re an oncologist, you’re doubtless going to be impressed as all hell and likely even feel inferior.

So if you need medical care for something, that basically means you should just listen, do as you’re told and assume you’re in good hands, yes? The doctor has at least a decade of knowledge that you don’t. Well, maybe not. The dirty secret I alluded to in my title is something that we recognize exists in schools and every single industry, but we never apply to medicine: there is a bell curve.

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Image source: https://empxtrack.com/blog/bell-curve-for-performance-appraisal/

Because it’s so hard to become and remain a doctor, we assume that they are all great or at the very least, all at a given level of expertise and commitment. We assume that they are all going to give us a similar level of care. Unfortunately, that’s just not true. As surgeon and author Atul Gawande says regarding bell curves in his book Better: A Surgeon’s Notes on Performance:

“…with a handful of teams showing disturbingly poor outcomes for their patients, a handful obtaining remarkable good results, and a great undistinguished middle. After an ordinary hernia operation, for example, the chances a patient will have a recurrent hernia are one in ten with surgeons at the unhappy end of the spectrum, one in twenty with those in the middle majority and under one in 500 with an elite handful.”

That’s a staggering thought, no? Healthcare has come such a long way in the last 50 years that we assume we’re going to get equal outcomes no matter which hospital we go to or which doctor sees us, but it’s not the case. The reality is that unless you take your healthcare into your own hands, it’s far more of a lucky dip than anyone wants to admit.

I want to tell you a story about two of my own experiences here which should prove enlightening…

Diagnosed with a heart condition

Back in 2017 at the relatively young age of 37 I was diagnosed with a heart condition. It wasn’t chronic — every few months I’d wake up in the morning and my heart would be in atrial fibrillation. After a couple of incidents and trips to the ER, I was told to see a cardiologist as this was clearly not a one off.

The doctors in the ER were pretty baffled. Someone of my age, not to mention healthy and athletic, presenting with afib isn’t unheard of, but it’s certainly rare. Usually you see it in 50+ year olds. So off I went in search of a cardiologist. The first one I saw was in my area and walking into his waiting room showed me just how rare my condition was for my age — everyone there was at the very least pushing 70.

The cardiologist was baffled and couldn’t understand why someone like me had the condition. He put me on a weeks long course of beta blockers, told me to stop drinking coffee and put a heart monitor on me for 24 hours to see what he could see. As my condition was sporadic, needless to say, he didn’t find anything.

Bottom line, he told me to only consume 1 cup of coffee per day and dial down my training routine, then sent me on my way.

Fast forward a few months, when I competed at nationals for strongman and then state titles a few months later. With the heavy training load my heart did it again, and this time they shocked my heart back into rhythm in the ER. It was time to find another cardiologist.

Enter the specialist…who specialized even further

This time my wife didn’t just find me a cardiologist, she found a cardiologist who specialized within his specialty. The difference could not have been more stark.

He went through my history and then told me everything he knew and his experience with what he’d seen, as a precursor to telling me that there are a lot of unknowns about the condition and he couldn’t give definitive answers on a range of things. He did offer me a range of options ranging from pill in pocket medication all the way up to surgery and told me the drawbacks of each one.

So what was the difference?

There were a few. The first cardiologist:

  • Put me on the same treatments as older people, including beta blockers. They made me feel tired all the time and I hated being on them.
  • He told me to cut out coffee.
  • After that, he was essentially out of ideas and didn’t seem too keen to do much else.

The second cardiologist?

  • Scoffed when I told him I like 3 cups of coffee a day. He told me it was fine and said that the literature on it was all clear — it does not affect afib.
  • He said there was no need for beta blockers.
  • He told me what the likely progression of my condition would look like, what my various options were at each point, and the odds of success of each.
  • He gave me an ideal solution for when my condition flares up that has worked well for the past couple of years and kept me out of hospital.
  • He was confident. This guy was an expert who knew what he knew and didn’t know.

Medicine is just like any other profession

So within the field of cardiology — a highly paid and respected specialty, I had two exceedingly different experiences. Despite it being a medical specialty, one doctor just went through the motions and did what he knew, while the second was clearly a high achiever who kept abreast of current research and was actually involved in research himself.

I have a friend who’s a doctor and was stunned when I heard him talking to an acquaintance who also has a heart condition. She’s a similar age to me but her condition is much more dangerous and was routinely landing her in hospital. He told her, and I paraphrase a bit here:

“When you go to the ER, ask for the cardiac registrar. Don’t just let the ER doctor do their thing with you, because it’s a crapshoot and you have no idea if you’re going to get a good doctor who knows what they’re doing with your condition.”

This is in Australia, where we rank 9th in the world for healthcare.

The fact you need to face

Now, it’s actually quite a positive thing that even with the worst doctor in an ER these days, you’re going to have way better outcomes than with the best doctor from 50 years ago. Healthcare advancing as a whole means we all reap the benefit, regardless of what level of treatment you can afford.

That said, there’s something you need to take with you and always remember:

You are the person most responsible for your own healthcare.

The simple fact is, we’re never going to get an accurate, public rating scale for doctors, just like we’ll never get one for teachers. These professions are deemed too selfless, too important to society for us to introduce such a vulgarity that’s standard practice in the business world. That doesn’t mean the bell curve doesn’t exist and that you shouldn’t be going for the better end of it.

Have a cold or a sore throat? Of course go and see your local general practice doctor and don’t think too much about it. If you have a serious condition, however, with long term or major implications, would you simply trust your local doctor just because it’s convenient? Or would you start looking towards the better end of the bell curve? People usually talk about getting a second opinion when it comes to major medical decisions, but how about we change that:

Go and get a better opinion.

It’ll likely cost more, it will be less convenient and maybe you’ll hear something you don’t want to hear, but it’s clearly the superior option. After all, do you want treatment from someone who’s just been going through the motions for years or even decades, or someone who is incredibly committed and is at the forefront?

The second experience

This isn’t limited to medicine either — all allied health is worth considering. Two weeks ago I popped my finger during my climbing session. If you go to any physiotherapist, it’s much the same as a cardiologist — full of old people who strain something getting out of a chair. So I contacted a sports physio friend of mine who competed with me in strongman. His response?

Bro I wouldn’t pay to come here. I can’t spend as much time with you as I want and I’m so busy in the clinic that I’m running around like a headless chicken. You should go to a climbing physio.”

This is a physio who specializes in sports, telling me straight up to go to someone who specializes even further in climbing. So I did. The experience was different to every other physio visit I’ve ever had. Usually, you’re one of 2–3 patients being seen at once and you have numerous follow ups afterwards.

The climbing physio? Apart from having been a professional rock climber, he’s a PhD in physiotherapy. Not only does he know climbing injuries inside and out, he knows climbers. He knows you’re eager to get back on the wall and what the dangers are because he’s seen it thousands of times. He also provided a specialty program for the next weeks.

Did it cost more than a regular physio? Yes, a fair bit. But it was worth every dollar.

Final reality check

You’re the person most responsible for your own healthcare and you can do one of two things:

  • Abrogate your responsibility to the healthcare system and treat it as a lucky dip, hoping for the best.
  • Staying as healthy as you can, ensuring you have money set aside for the best healthcare you can afford, and actually looking for the best healthcare for you.

The difference in choice can have life changing consequences. Go with the lucky dip option and you could find yourself dealing with anything from sub-optimal medication to having more of your intestine removed than necessary in surgery, resulting in you needing a bag the rest of your life. Even worse, it could be the difference between one doctor recognizing those spots on your lungs are cancer and another telling you that there’s nothing wrong.

This happened to an extended family member of mine, and she died as a result.

You have a choice with your healthcare — make the right one.

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I write about career, performance, psychology, self development and business humour. I'm an author, former national competitor in judo and strongman and a former military instructor.

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