Research vs Practice - Why Medicine is Slow to Change
I have now worked on three separate products in three totally separate fields of medicine. Each product was built on a revolutionary new idea and required that medicine be practiced differently. Each one was built on a strong scientific foundation, and made sense as soon as you thought about it.
Each one was met with incredible push back or foot dragging from medical practitioners.
I’ve spent a lot of time thinking about why this is, and I recently realized that “Medicine” as I think of it is actually two separate things.
Medical Science, done by a mix of PhD’s and MD’s. It seeks to understand the human body better, and in doing so create new ways to heal and prevent disease.
Medical Practice, performed solely by practitioners. It seeks to implement rules to treat disease.
Medical Science
In 1962, Thomas Kuhn wrote a groundbreaking book called The Structure of Scientific Revolutions. He said science is based on paradigms, or ways of thinking about the world. Scientific revolutions happen when we get new ways of seeing the world (telescopes, MRI, DNA sequencing) or new mental models for the world (game theory, germ theory, quantum theory).
Scientists work tirelessly to gather data that fits their paradigm. And every paradigm has data that doesn’t fit. Most scientists ignore this data as “outliers”. But, every so often, a totally green scientist finds a new paradigm that fits the data better. Eventually, people abandon the old paradigm for a new one.
A good scientist always assumes they don’t know the whole story, and looks for data that doesn’t fit their paradigm. When a better paradigm comes along, they evaluate it to see if it fits the data less badly. If it does, they adopt the new paradigm and move on.
Scientists don’t usually have to deal with the consequences of following an incorrect paradigm. Being incorrect is simply expected and accepted.
Medical Practice
In my experience, doctors, who are in the high stakes place of actually caring for real people, with real dreams and real families, are not scientists at all. (And arguably they shouldn’t be.) Most doctors are practitioners, meaning they put into practice the paradigms that are already settled on. A doctor’s mode is not to assume that they know nothing, it is to assume that they have a strong understanding of how the human body works and how to heal it.
Sticking to a paradigm allows a practitioner to hone their skills and get better at implementing a set of rules. This repetition also generates a lot of the data that goes back to scientists to affirm or challenge their paradigms.
But practitioners are very bad at changing paradigms. They say that it takes 20 years to change medical practice. They are basically saying that you have to wait for as long as it takes a new generation of doctors to learn the new science in medical school and then get far enough along in their careers to change practice guidelines, for medical practice to change.
Making changes is not what practitioners are trained to do. Further, changing things all the time instead of doing what is accepted and known could possibly cause a lot of harm. Practitioners being wrong is neither expected or accepted by their patients.
Why it Matters
For someone like me, who reads medical science, while my son’s doctors are practicing outdated medicine, this is incredibly frustrating. It’s also frustrating for everyone who has gotten a 2nd or 3rd opinion and gotten completely different answers from doctors all reading varyingly outdated information.
The point of this post is only that most doctors are not scientists, they are practitioners. Practitioners are not better or worse than scientists, they simply do completely different things.
Most of my own frustration and failure is expecting one to act like the other when they simply can't. By remembering the difference between the two, I can separate flashy discovery headlines from my expectations about how medicine will be practiced. And, I can be more thoughtful about how I work to bridge between the two.
