Should doctors be more than medical technicians?

I’ve thought of this question several times in the last few years, most recently in connection with two emergency room visits for my mother. She complained of (among other things) a very bad headache. Early on, one doctor ordered a ct scan of her head to see if there was maybe a tumor or something to explain the headache. The ct scan showed nothing out of the ordinary.

Here’s the bit that made me start wondering about doctor education, or intelligence or something: When the ct scan came back clean, the doctors then proceeded to completely ignore the headache. It was as if, when the test showed nothing, the problem simply ceased to exist.

This is the way not-very-skilled technicians operate. People who, in the IT field (my field) would be level 1 help desk and who would probably never progress beyond that level. Example (a real one):

Me: “I have a problem with my internet connection.”
Tech support: “I’ll test the line.” (pause) “The line is fine.”
Me: “Okay but I keep losing my connection.”
Tech support: “Restart your modem and check that it’s plugged in correctly.”
Me: “I did that. The modem is fine. There’s something wrong with the connection.”
Tech support: “I’m sorry sir but the line is clean. You need to check your modem.”
Me: “Aaaaaaaaauuuugggggghhhh!”

After a couple of days of arguing I got them to escalate to level 3 support, a real live engineer, who took about 5 seconds to discover that my connection was flapping. He sent out a technician who found that the physical line leading to the house was loose.

The trouble is, there’s no way to tell an emergency room doctor to “escalate my case to the next level.” And then there’s the not so small problem that if the level 1 doctor-technician doesn’t figure out that he needs to escalate, someone could die. Even if he does eventually figure it out, someone suffers while he fails to solve the problem.

Let’s go back to the analyzing this in the IT context. A user calls and says his screen is frozen. The mouse doesn’t move. A brand new help desk employee looks behind the computer, says, “The mouse is plugged in” and then walks away. If I ran the department, the IT worker who behaved that way would be given intensive schooling in how to troubleshoot a problem. This would include the most basic step of checking to see if a solution worked before giving up on the problem. If the schooling didn’t take, he would be unemployed.

It seems to me that the standard for doctors should be at least as high as for IT workers. Am I being unreasonable?

The problem may not be the standard for medical troubleshooters. Inexperience is another possibility. Several of the doctors looked young to me. Then again, I’m old enough that lots of people look young to me, even after I find out they have teenage children. Anyway, I would expect inexperienced people to be more obsessive about troubleshooting than more experienced people. Someone with more experience, after all, is better (or thinks they are) at knowing when something isn’t really a problem.

It seemed almost as if what we were seeing was some kind of cognitive deficit. When the test showed nothing, the doctors’ brains stopped processing the problem. It seemed as if they had become so dependent on the technology that when it failed to provide an answer, they simply stopped processing the problem. It was as if in their minds, the tech COULD NOT FAIL. If it showed nothing, there must be nothing to show.

As it turns out, other doctors were able to determine that there were other tests that could be run and treatments that could be tried even before seeing the test results. Hallelujah! Somebody did some thinking. The doctors who figured out what to do (we hope – the jury is still out on whether or not they succeed) were specialists and this too may be part of the problem. The specialists had expertise that allowed them to recognize signs that those outside their field did not.

Funny. In the TV show House, all the doctors always know everything about every field. The dwarven plastic surgeon knows all about rare genetic disorders. The arrogant neurologist with the inferiority complex can recite arcane details of the effects of poisoning by rare earth metals or almost unheard of kinds of cancer. The aggressively nice allergist knows how to run every piece of medical equipment and perform every medical test ever thought of, and interpret the results correctly. In real life, when we asked a surgeon what was wrong, he said, “I don’t know but whatever it is, it doesn’t need surgery.” (Seriously. He really said that. And this one even looked old enough to need to shave once in a while.)

Still, segmentation of skills can’t be too big a part of the problem we saw. After all, even a lowly help desk tech who doesn’t know what to do after seeing the mouse is plugged in, usually can figure out who to ask. This seems like a basic skill that anyone in a complicated field should have not to mention a direct consequence of basic human curiosity.

But what do I know? If I had any brains, I’d be a doctor.