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Why Do Good Doctors Disagree on Care Plans & Treatments? · Doctor Turned Health Coach

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  So, you go to one doctor and are told one thing, you're given a prescription
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  or recommended something, then you go to another doctor and get the exact opposite recommendation.
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  How frustrating it is to get different opinions or hear different opinions from
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  supposedly the same type of experts online. So today we're going to dive into that.
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  Why do doctors disagree?
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  What's at the root cause of physicians disagreeing on the practice of medicine?
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  Welcome to doctor-turned-health coach. My name is Dr. Mishori.
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  I'm a practicing board-certified family medicine physician with a health coaching
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  practice as well as a primary care practice.
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  We're going to go over about eight different points. And at the end of this
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  episode, I really want to arm you with some knowledge and information so that
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  you can tease out the way your doctor thinks and make sure that it is aligned
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  with the way you think about your health.
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  So number one, in medicine, we don't have a lot of facts.
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  Believe it or not, there are no facts in medicine. All we can do is design a
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  research study based on a hypothesis, and that study will either prove or disprove the hypothesis.
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  A few more years later, maybe that idea was wrong to begin with and we have
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  to now reimagine that hypothesis.
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  So there are no facts. There are only thoughts and ideas and directions.
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  And in some things, they're very firmly held and in other ways.
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  Areas of medicine, they're a little bit more loosely held. Number two,
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  different doctors see different patient populations. They see different types of patients.
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  If you work in upstate New York, you might see a more wealthy clientele with
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  a higher health literacy and more resources.
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  If you work in parts of central California, you might see patients with not
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  a lot of resources, poor communication skills, not even English as their first language.
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  And so the kind of patients they see, the kind of risk factors they have,
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  and the kind of treatments that work in one group may not work for another group.
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  Finally, I shouldn't say finally because we have many more points to go.
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  When it comes to the way different doctors practice, they were trained differently.
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  Number three, physicians were trained differently based on their medical school
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  training, their residency training, and then their fellowships if they're specialists.
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  So they will carry those
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  trainings with them and as we know except for
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  physicians who are very well read and are constantly reading
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  and are constantly checking their ideas at the door and saying okay i gotta
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  reimagine this concept one more time i gotta revisit diabetes in 2025 i gotta
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  revisit it in 2026 i gotta see what's new most are just unfortunately going
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  to practice what they learned Number four,
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  clinical protocols and guidelines, unfortunately.
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  Have deteriorated the quality of medicine.
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  What do I mean by that? So,
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  We can have one recommendation by the Obstetric Society of America,
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  a different recommendation by the Urogynecology Society of America,
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  and the Urologic Society of America, and then the Endocrine Society of America.
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  All of them addressing hormone health in women, maybe menopause, perimenopause.
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  Each will create a clinical guideline or a clinical protocol.
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  And oftentimes they're going to vary. One's going to recommend against topical
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  estrogen. The other one's going to recommend against oral estrogen.
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  So when doctors see that the actual clinical guidelines that people are,
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  random people, random doctors are coming up with, don't even agree with each
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  other, they become a bit disillusioned.
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  And most physicians prefer that there really wasn't a clinical guideline because
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  now we're relegated to do that exact practice. And if we practice in any other
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  way, we could be held liable.
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  Which may not be the best thing for the patient.
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  Sometimes patients also want to hear something very specific.
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  For example, in fibromyalgia, many times patients are so desperate for any kind
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  of treatment because fibromyalgia is such a tough disease.
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  And they want a medicine that works. They want a treatment that works.
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  And unfortunately, there are no well-proven medications that work in fibromyalgia.
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  But when we prescribe it because the patient is desperate, Well,
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  we're sort of catering to the patient's needs, but not to their actual overall health.
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  Number six, physicians, just like every other human being, are influenced by social media.
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  If a well-known doctor, well-respected doctor, Dr.
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  Gupta, Dr. Oz, Dr. Atiyah, Dr.
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  Williamson, Dr. Gundry, if these doctors are speaking out publicly,
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  somewhere in the back of their mind, the doctor, the physician,
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  the practicing physician, by the way, a lot of these physicians are.
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  They're not practicing quite as much, let's just say. These practicing physicians
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  are going to say, well, I mean, if these guys are given the floor and they're
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  the experts, well, my patients are going to bring that stuff into me. Maybe they're right.
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  Maybe I should try their style.
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  So that's unfortunately the influence that we see from social media.
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  Now, it's not always wrong, but it's always to be taken with a huge grain of salt.
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  Number seven clinical research is
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  often influenced by pharmaceutical
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  pressures so what i mean by that most of the clinical studies the clinical research
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  that we see is not high quality research and it's very common to find a study
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  that that in its data clearly shows that for example a carnivorous diet that's
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  raising LDL cholesterol,
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  is also increasing cardiovascular risk.
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  But then you go read the discussion section and the conclusion section,
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  and the authors say, and therefore we see that there is no direct correlation
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  with a carnivorous diet and any cardiovascular disease. And that's the problem.
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  It's a multifactorial problem.
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  Research writers want to publish things that the journals will publish,
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  and they are going to be forced to maybe do their scientific research in a way
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  that's not often beneficial to the overall patient population.
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  And the pharmaceutical industry will fund research that is likely going to be favorable.
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  They're not about to put up $100 million for a study that they think is going to go against them.
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  And the final point is that in clinical medicine right now, Most of us are getting
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  7 to 10 minutes per patient in primary care,
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  maybe 20 minutes in specialty care, and the wait time is so long that there
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  is not enough time to tease out
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  the nuances, to discuss all the different options available to someone.
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  When I want to discuss GLP-1s in a traditional insurance-based practice,
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  when I used to work in an insurance-based practice, it really just came down
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  to, hey, you know, this is what it does.
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  I couldn't really talk about maybe some of the other consequences,
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  side effects, maybe some other alternatives for the patient or help the patient
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  understand that this is a great medicine for you in the short run.
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  But in the long run, we really got to come up with an exit strategy as well
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  because it is expensive and it does have just a few small side effects worth considering.
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  So with that out of the way, let's go and kind of analyze the way doctors think.
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  So I'm going to arm you with a couple of questions. Don't worry,
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  I'm not going to take long.
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  I'm going to arm you with a couple of questions that you can ask your doctor,
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  probably not point blank, but indirectly, to get a sense of whether this physician
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  is going to be able to help you with your health problem and whether they think,
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  independently and can try to at least set some of their biases aside.
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  So number one, what is your philosophy to treating patients?
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  For example, the philosophy, it might be to improve their blood pressure numbers
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  and their hemoglobin A1c numbers.
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  Well, that's a good metric. It's a lab metric, but that philosophy is not to
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  actually help the patient feel their best.
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  The right philosophy, in my opinion, at least when I look for a doctor,
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  is that they're very much focused on the quality of life that I live and that
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  my treatment recommendations are in line with my ideal health outcomes.
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  What is it that I want to, what do I want in my health? We discussed that in
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  another episode before.
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  So that kind of physician is somebody that I would gravitate towards.
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  This question i think is also very important this is
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  a way a way to say it might be hey doc how
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  do you how do you make your decisions for patients how do you come
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  up what's your what's your heuristic what's the what's the model you follow
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  when you want to help somebody when you want to help them make a decision well
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  oftentimes a physician might say well it's based on the most evidence-based
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  guidelines right and then they you know what we just said about guidelines and
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  evidence-based as in research studies.
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  So maybe a different way to say it is, or a different way a physician might
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  answer is, well, I make my decisions based on the overall pool of data,
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  the cumulative data that comes in.
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  And for things that are very certain, I help my patients understand that this is very certain.
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  We really, really know that this treatment is going to have a very positive effect.
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  And I'll let them know when something's in the middle. And I will let them know
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  that even though these studies were published, there were not strong studies.
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  So unfortunately, we don't have any way to say that this medicine is safe or
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  this treatment protocol, this surgery, this chemo, this radiation therapy is going to be effective.
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  So this is the way to sort of get a sense for your doctor.
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  Now, of course, all of these other eight points that I mentioned,
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  you can kind of squeeze those into the conversation over time to get a sense
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  of your doctor's practice styles. And that is why so many doctors disagree in medicine.
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  I hope this is of value to you. If it's something that resonates with you,
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  please share it with somebody else. I would love it if you left me a review on Apple Podcast.
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  And you can go to the show description for links to work with me individually
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  if you think that I can help you in your healthy aging journey.