We like to believe that people are rational. We often argue that if we can marshal enough evidence to prove our point that we can win the day. The truth is actually much more complicated than that. It turns out that people are often guided by their emotions as much as their intellect. We often bow to tradition even when we know it might not be the correct path.
Doctors are no different than everyone else. Despite their long years of training, many of them are also subject to this effect. In this article from the Atlantic, many of them are demonstrating that it is often extremely difficult to undo years of practice even in the face of contradictory evidence.
David Jones tells the story in his book, Broken Hearts: The Tangled History of Cardiac Care. At first, cardiologists believed that coronary artery disease was due to cholesterol and other substances building up blockages. Bypass surgery, balloons, and stents helped to increase oxygenation and clean out the clogged arteries. These procedures became the gold standard in care. However, there were others who felt that heart attacks were due to ruptures caused by plaques built up with cholesterol and other substances. They felt that statins could help relieve these conditions and help reduce heart attacks.
Jones has other theories about why practice is slow to change:
Jones readily admits there are financial reasons for the continued use of these procedures. Bypass and angioplasty make money for physicians and hospitals. But other explanations—what he terms “emotional and psychological”—are more interesting and especially relevant to current debates about treating high cholesterol and hypertension.
The physician who wrote the article also adds his own opinion:
....Quite simply, it is hard to practice medicine one way for so many years and then change. I have become adept at mixing and matching medications to get to the old recommended levels while minimizing side effects. And while I do not do formal outcome studies on my patients, and some have clearly experienced heart-related issues, I can generally state that those that take their pills have done quite well.
But Jones’ research provides a cautionary tale for my type of reaction. Studies that asked cardiologists why they continued to recommend elective bypass and angioplasty despite the plaque hypothesis revealed emotional and psychological reasons of dubious validity. For example, some justified their decisions because they had a “zero tolerance” policy for angina. Others worried that they would have “anticipatory regret” if a patient who had not been revascularized had a heart attack. Others were disinclined to leave the catheterization lab without doing “something.” Finally, others feared lawsuits. None of these opinions, Jones correctly asserts, should carry the day.
We should keep these types of issues in mind as we develop new techniques and systems that might run counter to current practices. Even with documented proof, it will still require an extensive campaign to change hearts and minds!
Here is the link to the full article: When Doctors Act on Tradition and Emotion Over New Science - Barron H. Lerner - The Atlantic
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