KevinMD

This post is unrealistic in medicine, and really only works for less serious/elective care issues, not primary medicine, or where doctor and location choice actually matters.

As a starter: I'm woman with an extremely strong family history of breast cancer before age 50. Standard clinical guidelines is to start doing heavy monitoring 5-10 years before the youngest person in the family tree was affected, since usually cases get progressively younger start dates. Since one of the people was around age 32, I'm under the age of 30 and I go for mammograms, ultrasounds, and MRIs every year as if I were a cancer patient already.

Mammograms, ultrasounds, CAT Scans, MRIs, (any form of medical imaging radiography) are actually a perfect example of how the market internationally could be more efficient, but it turns out that's impossible. At its core we're basically talking about photographs, something facebook manages to serve from location a to person b that is nowhere near location a every day. Why couldn't I go to any imaging place in the US, and have my images sent to the lowest cost provider somewhere in india to be read and interpreted by a radiologist, and then have the results sent back to me. Unlike Chris, I don't even have to meet my doctor, all I have to do is send him images.

It turns out that medically this is blatantly difficult if not impossible to do. The reasons are 2 fold

1) It turns out that age and variations in how and why the machines that used, as well…

You note that in medicine and law women are no longer a minority, and that they receive equal pay, and nearly equal social power as their male counterparts.

Sorry to be [citation needed]-guy, but a quick Googling tells me that this is not true. In both medicine (http://www.kevinmd.com/blog/2011/02/gender-gap-physician-salaries.html) and law (http://www.theglasshammer.com/news/2009/02/05/the-wage-gap-puzzle-in-the-legal-profession-why-women-lawyers-still-earn-less-than-men-what-can-be-done-about-it/) the pay gap is substantial, and a quick look says that they're both worse than tech.

From that first link:

Without these adjustments and just looking at a Population Survey from 2007, the New York Times reported that women doctors earn a whopping 40% less than their male colleagues. That is worse than every other profession the Times looked at. Yes, even lawyers.

I don't think wage gap is what's pushing people away...the worst case difference in tech is around 10%, which is not particularly bad compared to most fields, and for recent grads the gap is much smaller, around 4%.

I'd probably look to absolute value of wages instead for an explanation, though that wouldn't explain a difference between men and women's preferences.

If you want to bring women into the industry, you need to make the industry appealing to women. With current discriminatory practices that is just not the case, and until that changes, there won't even be an opportunity to recruit women, because those…

I figured that was where they were going... but wanted to make sure - the word medic threw me.

"Do no harm" isn't as clear cut as that. You have to do harm all the time as a doctor - the question is what is the lesser harm? Would you rather have a few broken ribs, or a heart that isn't beating. Either way, you're causing harm. Most people would rather you crack a few ribs though.

(BTW, that phrase actually isn't part of the Hippocratic Oath [1][2])

Here's a different example. Is burning a religious text (Bible, Koran, etc...) ethical? What if it is in private? Is anyone harmed? Many people would consider this an unethical act, even if no one was around to see it. And if no one would see it (and thus be offended), where is the harm?

Another example: Imagine Alice is in a wheelchair and is shopping. She accidentally drops her phone on the floor. At that moment, Eve walks by, notices Alice struggling, and yet does nothing. Eve continues walking on her way. Did Eve cause Alice harm? Alice was already in trouble, and Eve didn't do anything help. However, Eve didn't do anything to cause Alice's problems. So you can't really claim that Eve harmed Alice, even though many would question her inaction.

This is just to point out that the concepts of harm and ethics aren't necessarily linked. But that is really moot in this case, because no one can really claim that this kid caused AOL no harm. It may just be really small in monetary terms.

[1]…

This is what I found within a couple minutes of Googling. Do you have any contrary information suggesting that the majority of doctors are in fact up-to-date with the latest academic journal articles published within their fields?

"One New England Journal of Medicine study found that patients get only 55 percent of the care that's recommended for the leading causes of death and disability. Similar research in children showed they get just 47 percent—and a mere 41 percent of preventive steps that are proved to help."[1]

"Despite 15 years of advances about what is known of [sinusitis], the information isn't making its way to internists because it is not been published in journals or other sources often reviewed by internists, who most often treat sinusitis. For instance, many internists are unaware that chronic sinusitis can cause serious chronic fatigue, Chester says."[2]

"It’s unrealistic to expect the majority of physicians to go back to the original literature or even to go back to systematic reviews of the original literature,” said Gordon Guyatt, MD, of McMaster University in Hamilton, Ontario, who is credited with coining the term “evidence-based medicine."[3]

"In a 2005 systematic review in the Archives of Internal Medicine, most studies found a correlation between increasing years in practice and decreasing quality of care."[3]

[1]http://www.rd.com/living-healthy/is-your-doctor-out-of-date/article166346.html

[2]…

There is no cardiovascular benefit for alcohol intake. The only evidence for this is an observational study, which does not prove causation at all and is heavily disputed. It would not be the first time that observational studies are proven wrong in actual trials :

> In recent years we have seen that the results of similar “observational” studies were disproved when subjected to a “randomized controlled trial”—the standard bearer of scientific proof. A good example of this is female hormone replacement. For decades it was believed that female hormone replacement was beneficial. But a randomized controlled trial, called the Women’s Health Initiative, demonstrated that the exact opposite was true. The study was stopped in 2002 because women taking the study pills of estrogen plus progestin were developing heart disease and breast cancer at increased rates compared to those taking the placebo or inactive pills."

http://www.kevinmd.com/blog/2011/01/red-wine-good-heart-brain.html

I can't match you on credentials or acronyms, but I'm pretty good at figuring out what matters for improving my own health.

"Should cardiologists evaluate their obsession with LDLs and HDLs?" - http://www.kevinmd.com/blog/2016/04/should-cardiologists-evaluate-their-obsession-with-ldls-and-hdls.html?pop=0&ba=1 (April 2016)

Saw this link on the sidebar:

"Slow Medicine: Pressing Pause on Statins For Primary Prevention" - http://www.medpagetoday.com/Blogs/SlowMedicine/61836 (December 4 2016)

I would estimate that the cholesterol fetish has about 2 more years before it begins to slide into irrelevance, and the field begins to refocus on the causes behind the symptom.

A classic fun movie clip: https://www.youtube.com/watch?v=02Or-Hx3yqc