TY - JOUR
T1 - Quixotic medicine
T2 - Physical and economic laws perilously disregarded in health care and medical education
AU - Haburchak, David R.
AU - Mitchell, Bradford C.
AU - Boomer, Craig J.
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2008/12
Y1 - 2008/12
N2 - Wise medical practice requires balancing the idealistic goals of medicine with the physical and economic realities of their application. Clinicians should know and employ the rules, maxims, and heuristics that summarize these goals and constraints. There has been little formal study of rules or laws pertaining to therapeutics and prognosis, so the authors postulate four physical and four economic laws that apply to health care: the laws of (1) finitude, (2) inertia, (3) entropy, and (4) the uncertainty principle; and the laws of (5) diminishing returns, (6) unintended consequences, (7) distribution, and (8) economizing. These laws manifest themselves in the absence of health, the pathogenesis of disease, prognosis, and the behaviors of participants in the health care enterprise. Physicians and the public perilously disregard these laws, frequently producing misdiagnoses, distraction, false expectations, unanticipated and undesirable outcomes, inequitable distribution of scarce resources, distrust, and cynicism: in short, quixotic medicine. The origins and public reinforcement of quixotic medicine make it deaf to calls for pragmatism. To achieve the Accreditation Council of Graduate Medical Education competency of systems-based practice, the authors recommend that premedical education return to a broader liberal arts curriculum and that medical education and training foster didactic and experiential knowledge of these eight laws.
AB - Wise medical practice requires balancing the idealistic goals of medicine with the physical and economic realities of their application. Clinicians should know and employ the rules, maxims, and heuristics that summarize these goals and constraints. There has been little formal study of rules or laws pertaining to therapeutics and prognosis, so the authors postulate four physical and four economic laws that apply to health care: the laws of (1) finitude, (2) inertia, (3) entropy, and (4) the uncertainty principle; and the laws of (5) diminishing returns, (6) unintended consequences, (7) distribution, and (8) economizing. These laws manifest themselves in the absence of health, the pathogenesis of disease, prognosis, and the behaviors of participants in the health care enterprise. Physicians and the public perilously disregard these laws, frequently producing misdiagnoses, distraction, false expectations, unanticipated and undesirable outcomes, inequitable distribution of scarce resources, distrust, and cynicism: in short, quixotic medicine. The origins and public reinforcement of quixotic medicine make it deaf to calls for pragmatism. To achieve the Accreditation Council of Graduate Medical Education competency of systems-based practice, the authors recommend that premedical education return to a broader liberal arts curriculum and that medical education and training foster didactic and experiential knowledge of these eight laws.
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U2 - 10.1097/ACM.0b013e31818c65c0
DO - 10.1097/ACM.0b013e31818c65c0
M3 - Review article
C2 - 19202481
AN - SCOPUS:60849128250
SN - 1040-2446
VL - 83
SP - 1140
EP - 1145
JO - Academic Medicine
JF - Academic Medicine
IS - 12
ER -