Changing the culture of American medicine – Start by removing hubris. (2013)

“As I grow older, the excessive pride and confidence of the medical establishment becomes more obvious. Why didn’t I see it before?

 John Mandrola, MD
Dr John M (personal blog), 28 July 2013.

“… A recent article, published in the journal Mayo Clinic Proceedings, provides chilling evidence that many well-established medical practices are wrong.

“In electrophysiology.. the AFFIRM trial found that using rhythm control drugs to maintain sinus rhythm in elderly asymptomatic patients with Atrial Fibrillation (AF) did not reduce stroke, hospitalization and death rates. To this day, nearly ten years out, I still see AF patients on rhythm drugs because a doctor thinks this strategy will prevent stroke or reduce the risk of death.

“In interventional cardiology, the idea that coronary blockages need to be ‘fixed’ is ingrained. … Then the COURAGE trial showed that implanting stents in patients with asymptomatic coronary disease was no better than optimal medical therapy and lifestyle modifications. Again, to this day, wide variations in cardiovascular care suggest too many doctors ignore scientific evidence.

“Hubris has to go. Though there is a role for ‘assess and decide’ in the practice of medicine, we must become more honest and skeptical with ourselves.”

Access the full blog at Changing the culture of American medicine