Why Are There So Few Good Doctors?

One in ten is a generous estimate of medical professionals who are highly knowledgeable and passionate about their work.  This is based entirely on my own interactions with everything from surgeons, specialists, pediatricians, ER doctors, and more.

From a customer standpoint, this sucks.  A tepid box-checker is a poor vendor of any good or service, not just health.  When you get your car fixed, you want the guy who’s fascinated by the clunking noise and getting all House M.D. in his zeal to find and fix it.  You want the lifetime gearhead who dreams about pistons at night.  When it’s your body, you want the actual House M.D.

But you’re almost never going to get it.

Most medical professionals aren’t very sharp, interested, passionate, or eager.  Not trying to be rude, they just aren’t.  It’s almost always a lackluster if not downright crappy experience.  They aren’t thrilled by sleuthing the root cause behind the symptoms in your unique body.  They rattle off tons of drugs they haven’t studied that might dull the symptoms, classify you with a government/insurance approved code, order several useless tests, and blather some condescending thing about flu-shots or the latest seasonal scare.

I suspect the reasons for the disinterest in most medical professionals are several.

  1. They pursued the career for prestige, not intrinsic interest.
  2. Intrinsic interest was beaten out of them in the industrial schooling system.
  3. They are protected by a labyrinth of government regulations and monopoly status, so the incentive is to master the government game rather than master the craft, since the former is rewarded and the latter isn’t.
  4. They have grown intellectually arrogant and stagnant due to the universal respect and awe in which they are held by a credential-worshiping media and public.
  5. They were schooled in a “lump of dough” philosophy that treats problems and solutions in aggregate and plays down biological diversity while playing up one-size-fits all scientism.

It seems dentists, and especially chiropractors, have a much higher rate of deep interest in their field.  Midwives and doulas have a ridiculous, almost pathological love for their craft.

Not surprisingly, they have less of all of the above.  Their fields are less prestigious, less monopolized and cartelized with legal privilege, and they are less revered.  In the midwife/doula case, they almost never get reimbursed by insurance or recommended by the health industry, so they have to win and keep customers themselves like a self-respecting market participant.  They often face legal obstacles that make their practice borderline banned.  You’ve gotta be driven by a deep interest to persist in those cases.

Incentives matter more than anyone thinks.  The medical licensing regime is one of the more pernicious and pervasive elements of society.

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