Are Doctors Just Doing Cookbook Medicine? (“Useful Idiots”) 

In aviation, there is a strong emphasis on following checklists and protocols. They are there for a reason. Time, and time again, it's been shown that so many incidents happen when people don't follow the checklist, and plenty of incidents have been prevented when people DID follow the checklist. BUT, the key isn't blind checklist following, this too has led to horrendous incidents, you need to be keenly aware of the systems and be able to switch to thinking very critically about everything that you are doing when a real issue comes up, that is where training for the unexpected comes up. That scenario though is the exception, not the rule. Don't fly like Sully when everything is going fine, but DO fly like Sully when the proverbial s*it hits the fans. Medicine is no different. Follow the protocol, but be ready to switch to your foundational training when the situation calls for it. The protocol is there for safety, but patients aren't clones, each and everyone is different and unique.

As a family physician for over 25 years, thank you for saying this so eloquently. And I must be really dumb because I have missed out on all of the kickbacks that big business and big Pharma have owed me for prescribing medication and performing procedures over the past quarter of a century.

Actually I love the cookbook analogy, because a good cook never follows a recipe blindly but uses it as a guide and knows often you have to modify, substitute, or skip steps. Just like medicine! So I don't think this person actually understands medicine or cooking 😂

If you don't follow protocol you don't get it paid for by the third party payor......... I have watched the transition since 1980 ....ICU RN 43yrs..... I have to see my doctor when medicare now tells me it is "required"....... not when I feel a need to see a doctor..... if you fall "out of compliance" you are tagged "noncompliant".......

I still believe that medicine is as much of an art as a science. People don't neatly fit into categories.

so many patients do not follow textbook presentations. this stance is so easier to disprove it’s ridiculous

Nuance in the world of medicine belongs to the insurance industry and their formularies and established protocols. Doctors don't want to fight the system, don't want to really know their patients and just want their malpractice premiums to stay as low as possible. More often than not, they are salaried bots who collect a paycheck and perks and are just looking toward early retirement and a new set of golf clubs to go with the new girlfriend, both of which get taken to the next convention. Report suspect or substandard behavior to a medical board (or nursing board, we all have N.P.s now) and see how fast they circle the wagons to not tell you their findings after "investigation", which will likely take many months. In the meantime, the overscheduled N.P. who neglected to tell you you tested positive for MRSA in your sinus cavities before she moved on to another urgent care center doesn't even have to apologize, and won't even sound like she's sorry until she finds out you did report her.

What you say makes me thing of my former docter (he retired, unfortunately for me). We tried to find the right dose of medicine gor my hypothyroidism. He once told me 'your blood values seem fine at the moment. But I treat patients, not blood values. How do you feel'. I felt so seen and heard. He followed guidelines, but could take a step back and look at the patient behind those guidlines.

I think the concern is less about the doctor not having any relevant role; I think it's more about the potential for the institutions which establish the protocols to have motivations for doing so improperly, and then seeing it seem as if the doctor is not skeptically scrutinizing those protocols. After 2020, it's now rather far-fetched for anyone to not have such concerns and skepticism. Even if a doctor is impressively well educated, I'm skeptical of the academia which educated him. Not that I think it's all bad, but I do think it's some bad, and it would be nice to see medicine freed from the pitfalls of academia; of course, academia is what it is, and so it by nature has its benefits and detriments.

Im an infectious disease Dr at Harvard, and I wish it was all about following a flow chart. I would much happier and stress free.

They call medicine a “practice” for a reason

it took you almost minutes to prove his point.bravo

Doc Schmidt, you reassure me everyday that medicine is still worth it. So many medical students worry about just becoming another cog in the machine and videos like this really help us not be so fatalistic.

As a patient I see doctors who follow a “cookbook” and doctors who do much more than that. I’ve seen an increase over the years in internists who seem to spend all of their time reading test results and not looking at me physically. That can get annoying. Why not take five minutes to check my ankles for pad? I am very frustrated with the lack of support for my pre-diabetes. I see other specialists who point out diabetes symptoms and ask if I’m being monitored. But my ac1 doesn’t trip over the line for medication and I seem to have to continue to insist on the ac1 remaining on my test list. After a TIA/progression of migraine last year I was sent to a neurologist who stated that I didn’t fit into either diagnosis neatly, we’re taking that seriously, here’s meds, here’s a list of supplements. But the neurologist left the practice, I am told my internist can just continue to prescribe the meds. But other than continuing the prescription already in place, she doesn’t seem to take this seriously. She thought I was being a bit silly even asking for a neurologist consult since ct scan showed no damage. That was after 20 minutes of aphasia. Some doctors use the guidelines as a jumping off place and work with you if you don’t fit neatly into a flowchart. Others insist you don’t need attention if you don’t fit neatly into a flowchart. I don’t think it’s big pharma. I think it’s doctors with schedules they have to adhere to and too many patients to allow for customizing their approach to patients who don’t neatly fit. But it isn’t the best way to practice.

Even if you were "just following a cookbook" I'd prefer someone who has experience and training using that cook book, vs me who can quite literally screw up following an actual cook book. Nobody has authority quite like ignorance, so naturally the less I know about being a Dr. the easier it seems to me.

The "evidence-based" argument kind of goes out the window when you're just following the flow chart instead of running lab tests, no? I'm speaking from experience here: I had a _3 month headache_ (not headaches, plural, just one long, constant one for months on end) and I could not find a doctor anywhere willing to even try to figure out why. Just (Patient has headache)->(Recommend Tylenol)->(Recommend Therapist). Go to the same doctor 4 times, for the same issue, get that same flow chart response. Go to different doctors, get the same thing. Got told to "just keep alternating Tylenol and Advil and wait 2 more weeks, then we'll do tests, for real this time" every time I came back and begged for just one lab test to try and figure out what was going on. Scariest experience of my life, and not one doctor out of almost a dozen I saw even pretended to care. I made peace with the concept of death at age 21, while doctors were just like "This might just be unusually delayed vaccine side effects. Or maybe not. Who knows. Weird." A highlight of the experience was the one "test" that was performed, when I mentioned at one of the urgent cares that I had family history of cancer and that I was worried it was a tumor or something. The doc asked me to stick out my fists. He grasped my fists with his hands, and told me to push him. I gave him a gentle shove, and he requested again "Really push." I pushed him hard, he staggered back, and assured me that I don't have cancer, because "I showed no signs of muscle weakness." This doctor was a frail old Asian guy in his 70s or 80s, and I'm in my 20s and haul refrigerators for a living: whether or not I could put Gampy through a wall if I really tried probably isn't a reliable cancer test. "Evidence-based procedure" my ass. Procedure is written up by hospital administrators to monetize patient desperation and it'll take a lot more evidence than what's presented in this video to change my mind.

I agree with you Doc S after working in various medical setting that most "good" doctors want more. However, as time goes on some docs lose that edge after having to fight insurance, regulations and investors buying hospitals, urgent care, surgical and others from outside the healing arts of medicine. May you never lose your edge.

Our system is a joke. With my Epilepsy I have had nothing but problems and Assumptions from those with that piece of paper that says they're 'smart'. I could give events but it would be a book full of disgust how the patient is treated by those on their high horse. My life was put at risk more than enough times but they for some reason always had the legal right to do so. Like let me sign myself out thinking I was angry when the reality was it I was having an Amnesia Seizure that you guyes have never put on file even though it's clearly stated in the Epilepsy Foundation listings of all forms And I have been in your ER + Neurologist's for how many years now, and due to a Seizure. I don't need to go to college to educate on a condition I lived with for 30 years.

As a diabetic, Type 3C with half a pancreas, I'm glad GI exists.

Most of the doctors I have run into have followed canned protocols and didn’t look at the whole picture, didn’t listen, etc. Diagnostic criteria were developed initially to help doctors make diagnoses when they had no experience with a disease, but now they narrow to the point that outliers can never get diagnosed, and thus treatment. They have become a way for those practitioners who prefer not to learn or think critically to make diagnoses, but easily dismiss patients who don’t fit those criteria as making it up, etc. I have a genetic disease that used to be called rare, but I have known for many years that it isn’t even uncommon, and so many people like me spent years, decades, trying to get doctors to pay attention only to be dismissed. Becoming a practitioner isn’t easy in this world, and there is a dearth of them, so I suppose in order to get enough qualified professionals, we need to have that criteria set forth. Just know that YOU are far more than just qualified.

@Doc Schmidt • Although the RU-vidr used deliberately hurtful language, I'm glad you were tagged on this video at the start of your practice, rather than the end. This timing allowed you to give a thoughtful response. I think the problem is from a patients perspective, we are not privy to the thoought process of the doctor. Consequently, the doctor may appear to be robotic when, in fact, he or she has made many yes/no decisions before recommending a treatment. Combine this lack of transparency with the difficulty in finding a doctor and getting an appointment in many localities and the patient is primed to accept the "useful idiot" theory. From a patient's perspective, the best thing to do is to try to stay healthy, which is usually recommended by our grandparents but rarely role-modeled by the people we tend to idolize when we should be establishing those helpful habits. Just stay strong and remember why you entered medicine to begin with. Every business or industry has its administrative burdens that become wearying over time so you need to be aware of that so you can avoid letting it affect how you practice. Good luck and may all your patients get healthy and thank you for it. (Wishful thinking can't hurt. 😉)

The problem wih following protocol is that doctors ARE following the cookbook of treating symptoms and not conditions.

I dont know, my doctors all try to squeeze me into one box and seem to not want to explore other paths. Hats off to docs that do though 👍🏾

You are 100% correct, and this is the hallmark of a good physician. BUT we need to admit that SOME doctors are lazy and will force all patients in an algorithm of tx without trying to tailor to individual needs, once they are not ready to take the time or put the effort into the job they become indeed useful idiots. I'm always shocked by the difference in quality of care a patient can get from 2 different doctors in the same specialty. I might be wrong due to lack of experience, but from a med student perspective this is what it seems like.

There are a lot of great docs out there - just as you describe. There are also a lot of horrible ones. Misapplied medicine has taken the lives of several of my friends and family - like the friend who died of a brain tumor after her doc treated her for depression instead of finding the cancer. Or the doc who fired my Mom after failing to diagnose obvious, terminal disease processes, and taking her money for years - his letter refusing to treat her was still in her purse when she died shortly thereafter. Sadly - the good docs get the fallout from the resentment & mistrust created by the bad ones.

Thanks for acknowledging that people suffer with things that don't follow the flow chart. Now need MD to realize some bodies will keep reacting strangely. Almost died of sepsis because wbc fever stayed low til appendix ruptured. Surgeon wanted evidence severe pain at macbernies point,nausea wasn't enough. Told him he could diagnose on autopsy. Quickly went to OR, ruptured when he touched appendix and BP crashed, temp soared.😢😢

I love that Docs humor is always actually funny, while all of his serious content feels so genuine and on point.

I did my undergrad in cognitive science, and when it comes to psychology of reasoning and decision making, research shows that even highly educated people with statistics backgrounds are bad at avoiding fallible mental shortcuts based on preconceived notions and stereotypes. Protocols help us avoid this. People don't always fit the molds perfectly, but more often than not their conditions are resolved with prototypical treatments. And if they aren't, you adjust and try again. Thanks for pointing out the major flaws in this video's line of thinking, and I hope the majority of people aren't thinking like that

Very well said,and I appreciate your insight.

This seasoned Family Doctor appreciates your pearls - keep it up!

Protocols are good so long as they're not too rigid. A doctor once told me that 1 in 50 patients presenting with chest pain that are discharged from hospital will have had a missed MI. Protocols exist to minimise these kind of mistakes. They only become a problem when they prevent doctors from using their clinical judgement.

I think something people need to realise is that doctors also aren’t telepathic. They cant magically know everything that is wrong with you, it’s up to you to take control of the situation and tell the doctor what hurts where (a simplification obvs). Id say it’s good for patients to also google their symptoms, but this probably only works for some people. Id say you also need to be good at critical thinking to do this. I had to do this for my Temporal Lobe Epilepsy with the help of a friend. For years this was undiagnosed as I wasn’t giving great explanations of the problem.

Very well said, doc!

You explained that well. Thank you.

I prefer the doctors that think on their own. Medications are not the best way. You only think that because that's what the recipe says.

Relative to corporate masters, I do feel that providers are being pushed to meet profit-making goals for investors, like seeing a certain number of patients in a day or allowing them only 10 or 15 minutes with each one. I hate this and it seems contrary to adequate medical care. I'm happy to know there is a reason for the new computerized systems that seem to be a bane of every doctor; it does seem like they are being forced to stay within so many parameters that it's impossible for them to even think outside the box (or they are afraid to).

Eh, I've met terrible doctors, who had no intuition and tried to fit square pegs through round holes. I have several separate unusual health issues that complicate one another's treatment, and I'd say only 20% of the doctors I've interacted with have had the intelligence and patience to actually treat me properly and not recommend interventions that made my health worse. I come from an MD family, have MD friends, and work in clinical research myself, and it is really frustrating working with subpar doctors, it's liking going on one bad blind date after another.

Checklist manifesto. Physician. Pilot. All these checklists save lives. I would also argue we as physicians have the ability to recognize when something doesn't follow "the guideline" or "the protocol". Medicine as always, is a form of art.

And yes, doctors do please corporate entities because if they didn’t, then the opioid crisis want to have even happened… They were getting paid through pharmaceutical companies to prescribe medicine without any further information on it

yes my doctor follows just cookbook medicine and not regarding my concerns. He said oh we will give you medications for your inflamed foot (erysipela) and it will be better. Unfortunately it wasnt better :/ the lab results showed a normal value (CRP, BLS, etc) and he had no clue why my foot was still visibly swollen and red. the other doctor (consult) ranted half the time about my weight... not contributing anything to the situation... and finally he helped me by ordering to bound it very tightly so that the flow will be back . after 2 days and no confirmed (only lightly because he saw my foot being slightly less swollen, he decided to remove me from the hospital, saying it makes no sense to watch me get better just by lying there. the protocol says just start the compression therapy when the inflammation isnt there any more.

David Sacket’s definition of evidence based medicine: The integration of best clinical evidence, clinical expertise, and the patient’s wishes into decision making. All three are important.

😭 please more doctors who get taught about chronic illnesses please and teach doctors not to be ableist 🤦‍♀️ I've been mistreated more now that I'm ambulatory wheelchair user + chronic illness + plus sized than I've ever encountered (I've had chronic illnesses for a decade now just got worse before anyone comes after me yes I'm working on my weight that doesn't shed in one day tyvm) It's appalling. I say chronic pain and they keep pushing and pushing instead of worrying about why I'm there in the first place

So true. As a doctor it seems like practically none of my patients fit the text book definition of a disease. You kind of have to ask a lot of questions, do a lot of tests, and choose what best fits. Guidelines help determine what typically provides the best outcome but I still make changes depending on what meds are covered or available based on experience (i practice in an underserved area, the pharmacies here can't even get some of the basic meds i used frequently in school). I also know my patients and know the culture of patients in my area based on experience. So really it's a complex combination of guidelines, knowledge, intuition, and experience that we use to treat patients.

Quick question: Do hospitals have regulations to force a certain treatment/medication? Thank you for your insight, love the videos!

I think you're both right. Yes, often times doctors will diverge from the usual protocols and be extremely helpful and catch things because they did just that. Case in point, the neurologist who evaluated me to make sure my migraines weren't anything serious, and noticed during the exam that I had several indicators of EDS and got me in to a geneticist. But also sometimes doctors will follow their routine protocol and ignore everything that they observe outside of that. Case in point, the FIVE orthopedics and FOUR physical therapists I had seen in the 15 years prior to that neurologist who all noted that in addition to the specific joint I was seeking help for I also had extreme hypermobility in many joints, hyperextensible skin, easy bruising, and generalized chronic joint pain. 15 years without the proper diagnosis because they were following the routine diagnosis and treatment protocol for a specific joint injury.

The physician speaking is a wonderful practitioner. Dr. Schmidt, you must remember that you are rare. Your understanding is exemplary. Your patients are very lucky.

I believe in following guidelines by understanding the populations studied, the conditions studied under, and the analysis. The landmark study leading to a recommendation may not match your patient population and this is where our critical thinking (from training and experience )and shared informed decision making with the patient really matters the most

For the two dozen people who have watched both this clip and The Castle, the original commenter feels a lot like Dennis Denuto (the lawyer). "Medical schools are paid by the pharmaceutical company to create useful idiots. It's the vibe of it, your Honour."

Thank you for explaining how that guy is so incredibly wrong and trying to get people all up in arms. Protocols exist to assist with all the complexities of medicine. You're so right about patients not fitting perfectly into a protocol.

I've been mindlessly run through a procedure multiple times before, including a time when I knew what was wrong with me and didn't get asked any questions to elicit that knowledge. I'd rather my doctor try to use a little more intuition.

When the doctor doesn't listen to you or even LOOK at you. When you have a condition that doesn't fit into that flow chart and are told it is in your head that is where there is a problem.

Doc Schmidt thank you for making this great content

So what if a doctor uses a flowchart? I would imagine that in most cases, the treatment protocol for a disease is going to be largely the same. Pt has high blood pressure, give them 25 mg lisinopril, see if that helps and if not up the dose or change medicine.

Useful idiots??? That was rude!

FIRST‽ As someone with a chronic autoimmune disease (Sarcoidosis) and chronic pain I have seen far too many "Useful Idiots" and doctors wanting to pass the buck to someone else instead of treating some aspect of my disease. Thankfully I can go to the Cleveland Clinic Sarcoidosis Center now or I don't think I'd be getting any treatment whatsoever.

I think relying on checklists and each other's combined knowledge is a great thing. It frees you of the stuff that's already been figured out

All excellent points, you should be our spokesperson 😄

Doc, I’m not asking for medical advice, I just want to share a medical story. 5 years ago, when I was 9 or 10, I suffered acute pancreatitis, at first they thought it was appendicitis, luckily they realized and I got the medical help I actually needed rather than having my appendix removed. Sadly half of it liquified and I’m not a type 3C diabetic

Show me a good "official" doctor- and ill show you the door!

I appreciate and respect you coming at this the way you did. I think that there are a good group of drs who follow protocol to the T and don’t deviate. This in turn keeps patients like me from getting testing/treatment/diagnosis. We need more critical thinkers who aren’t afraid to look outside the box and deviate from protocol to get patients answers.

It sounds like you have the cocktail to the h. Pylori reset. Yet, says he needs regs to situate his patient? Can you help me? I have a whole list of things we need to run through to get to where I need to be. They are not suggesting you have to work off broken pieces.

It seems like this idea of protocol = always bad comes from this idea that a healthcare worker should have total mastery over medicine. This might have been possible in the past (past medical education model was basically: learn everything and apply what you know), but the current med education model is much more nuanced. It has to be because we now have more access to information than any other group of humans in all of history combined. It is impossible for any single doctor to know everything AND stay fully up to date with EVERY single advancement. This is the reason we have protocols and flow charts. Because otherwise a doctor (or anyone for that matter) would just sink in this vast and ever expanding sea of knowledge. All this being said, the key with protocols is to understand the fundamentals behind them and have a solid knowledgebase to know when to use the correct one and to identify when an algorithm isn't working. Protocols are safety rails there to protect patient and physician. But it is up to the physician to know when to override the protocol and make an evidence based decision.

Spot on

Living in Canada I have a different perspective on this. Doctors here instead of corporate interests they serve the government’s interests, and I feel our system has made a lot of “useful idiots”. I say this as someone who hopes to go to medical school when I finish some other academic goals. I’ve actually sat in in many classes at my university’s med school and have multiple friends who are med students, docs, and public health policy students. My observation in family medicine: there is a distinct bell curve in doctors competence and ability. You either have intelligent, motivated doctors who are capable of seeing nuance in guidelines, but there are also many who do the bare minimum because the interests of the government incentivize not spending money on things you don’t need. This causes many docs who just follow the guidelines to do the bare minimum.

I'm not sure what was going on with that video, perhaps it's inflamatory on purpose ... but I think we have a certain number of "useful idiots" - I went through so many docs that made me walk out with a prescription for bactrim despite telling them it's never worked for me in my life and that was becasue (they told me this is why) the protocols said give bactrim first and if patient doesn't respond then try whatever came next... it only stopped after I had a severe allergic reaction to a higher dose... I now can't take bactrim or any sulfa drugs because they might kill me but before it was EVERY time I had a new doctor my whole life growing up with one exception - that exception is the deciding factor reason I went to that doctor. I think the truth is that both sides are right.... most doctors are not "usefull idiots" but enough are that we've almost all had at least one and that makes it easy for a video like the inflamatory one to get views.... he's not inventing a sentiment, he's tapping into one and that one is coming from somewhere real. I've had enough bad medical experiences that I'm really wary of medical staff in general and most people I know feel the same... we're all poor so that may make a difference... I get defending how hard medicine is and pointing out that what that man said is not the majority of doctors, but to dismiss it entirely also dismisses the real world experience of so many patients. I think the real thing we should be looking at is what's going wrong in the medical industry (not with the doctors) that leads to these situations and experiences. Somethin (a lot of things) ain't right.

Bravo doc Schmidt bravo 💪

Lol ask any administrator how difficult it is to try and tell a doctor what to do 😂😂😂

There are protocols that use medical and nursing practices to make care more efficacious and SAFER! Good examples are protocols for care of central lines and IVs; care of urinary catheters. I could site many more. The gentleman claiming useful idiots is obviously British and very likely an NHS doctor. The front line general practice doctors are caring for 90% of the health care with only 10% of the NHS budget. Many are getting salary reductions because the government is so broke. This leads to incredible burnout. They are literally allowed only 10 minutes per patient. It is absolutely crazy over there. My guess is he’s feeling frustrated by how little he can help his patients because of restrictions, not to mention stressed by the volume.

I would be thrilled to have a doctor use his intuition and/or prior experience instead of using a flow chart that doesn't include anything other than the one outcome. They kept my son sick for 53 YEARS until I figured out what was wrong with him. But what should I have expected since there is no te$t for gluten intolerance but plenty of drug$ to treat his indigestion, migraines, anxiety, high blood pressure, border line thyroid, etc, etc. For 53 YEARS. What if I had never figured it out? And why didn't I question them sooner? And why didn't I try harder to figure it out? He was deteriorating in front of me and getting a new Rx every week at the ER. I am disgusted with the "medical care" available where we live. And now that I DO have it figured out and he is doing 1000% better on a gluten free diet his primary said it couldn't be that. Needless to say we no longer go there.

The problem is most doctors using these specific flow charts are Not using their critical thinking skills! Like not giving you a referral to a certain specialist because you don't meet the requirements for going, according to this doctor and protocol questions. Even though you're having specific ongoing symptoms that the PCP can't figure out and you're suffering in pain.

I think with the original speaker was trying to say is that not everybody fits into a protocol. And that a lot of times doctors really are just stuck to protocols that sometimes don't work, or don't even apply. And also when there are new treatments discovered, that aren't necessarily approved by the American medical association or said authorities, doctors do not have the legal freedom to practice, they have to stick with the "cookbook". (And yes, this is mainly for safety). For example, there are doctors using high concentration intravenous vitamin C treatment, as well as sodium bicarbonate treatment and are having pretty good results. You won't hear about that here, and it won't be an option, probably ever, as traditional cancer treatments make a ton of money. And we can argue whether chemo and radiation are effective or not, but we know they come at a cost (financially and to one's body). Vitamin C is not expensive and not shown to be harmful, even in high doses, and same woth sodium bicarbonate when administered correctly. I know stuff like this is a double edged sword. Following strict protocols prevents bad medical practice, and ineffective or dangerous treatments. However it keeps people from exploring other options. It's their health after all. This goes for disease prevention too. I mean seriously, doctors don't even talk about how to be healthy. I mean you have to go to RU-vid to get health advice, I mean actual advice on what foods to eat to simply be healthy. And unfortunately no, it's not common sense anymore, as it should be. I think we all know that healthy people don't make money, and that's not being cynical towards mainstream medicine, that's just a fact.

have you parodied an electrophysiologist before?… they love their squiggly lines!

Thank you for knowing more than me to help me stay alive, even if I give you a hard time because I don't know half of the big picture regarding the medical industry. ❤ Humans hey? 😅

The problem is most doctors are just not that sharp.. So they rely on cookbooks to keep the waiting line moving. Here's why the cookbook approach is bad practice. My wife for over a year complaint about abdominal pain. On her 3rd trip, I: decided to accompany her. The doctor actually cited from a checklist and at the end says my wife doesn't have any blah blah, come back next month. I said to the doctor, "she's' not coming back implying she might die." He finally ordered a blood test and her white blood count was off the chart. I then spoke with a surgeon and ask if she might be having appendicitis. He said, "I never heard of an appendix rupture lasting over a year". The operation began at 9 pm, lasted til 2am. The surgeon show me her tatted appendix and said, "I've never seen an appendix burst and heal, burst and heal and the person survive. So another non-textbook case, where my diagnosis was better than two doctors. Because I wasn't educated out of my mind, as my newsletter doctor Bruce West wont to say.

I don't know what point the man in the video was trying to make. But to me the sentiment seems to come from the idea that Western medicine treats symptoms and not causes. You tell your doctor you have a symptom, they say OK this medicine treats that symptom. But they don't look for the cause of that symptom.

I bet this guy would love a "useful idiot" to take care of him if he was injured in a car accident or needed emergency surgery. Or if he had a heart attack.

On one level, I agree with you, but on another it would be disingenuous to say I don't know exactly what the original video is referring to. I am on a community pharmacy rotation, and just came across a patient whose case was recommended by an automated system that noticed a "substandard antidepressant". It was a TCA being used for IBS-D. I knew this immediately, and it was an appropriate use, however, it would be in the best financial interest of the pharmacy to attempt to get this changed, because overall success stats are factored into compensation. There are absolutely forces that attempt to game the system at every turn, and on every axis it can be financially gamed.

Nuisance is why A.I Doctors will never be a thing. The computer doesn't know/can't understand that your back hurts because you stand for 6 hours a day. Itx doesn't know to push to that to side for now and factor it back in to make a differential DX.

Robotic protocol followers. Call me cynical, but that describes my PCP exactly. Pretty sure he's aged out of the industry and just doesn't give a fugg anymore.

Dr Schmidt you answered that in a very humble and simple way so that even regular people can understand why these regulations exist. Thanks a lot. To be honest, a fool like that guy making such absurd statements really doesn’t deserve the time of day from anyone. But since on the internet people like him have the ability to sway regular people into ignorance, I find that today it is necessary to refute misinformation like that, not to turn their individual opinion, but more so to prevent public opinion from going that way.

Interesting…. Because I feel like this is how Drs see the imaging techs at hospitals Useful idiots…. Doesn’t feel good does it! Now what you’re describing this is exactly how the radiographers / technologists work out exactly which protocol to use when we get a request…. In Australia, senior radiographers often do the protocolling. The radiologist is far too busy reporting and is often only consulted if available. I’ll just say, it’s really difficult when you don’t have the information needed to work out which projections to add to a series…..or the phases to scan because someone has the mindset that radiology if full of useless idiots that just follow protocols and push buttons all day…. Not all cans of a body part are the same so it does matter. Pop some clinny deets on that little old request form ( and yes, that’s a request form not a lunch order or a shopping list.) The radiographer NEEDS this to ensure the correct X-ray views and ct phases are are done for your patient. I’ll give you an example… Ie let’s look at a wrist X-ray..wrist with the details of “fall ? # “ Now that doesn’t really help us...try “FOOSH, unable to ulna deviate. Pain at anatomical snuff box. ? Scaphoid #. The first request will get you a standard series… no scaphoid views. Don’t mention mechanism of injury, or where the pain is and 9 times out of 10 the tech will not do a scaphoid series. Even giving us the mechanism of injury for this indicates that a scaphoid series may be required. I tend to ask my patients and check ulna deviation ….. but not all radiographers do because that’s not really our job. We have leniency to add if required but we’re supposed to do the images indicated by the clinical details given on the form. Mechanism of injury is great to add to trauma requests. We have certain views for certain body parts and we do know what the likely pathology is by the mechanism of injury. We spent 4 years at uni learning that stuff! In ct it’s even more important… CT abdomen” with the clinical information of “pain” will get you a PV abdomen. In some places you’ll get a non contrast abdomen. Do the need oral contrast… etc There are so many different scans and phases. But if you can’t give us clear clinical indications, and you’re hard to get a hold of, are known to be rude or difficult or mean - you get a generic non contrast or a PV abdomen. So please don’t complain that we didn’t do an angio of the abdominal aorta or a ct KUB with contrast including delay and prone acquisitions when all we’ve been given is “pain” to work with. And Please remember that the radiologist is doing what they can with the clinical information given on the form and the images us radiographers have been able to provide with the same lack of information. Don’t forget They don’t have the benefit of seeing the patient or doing and clinical/ physical observations. So if you get a vague report maybe the request was equally as vague.

I have great respect for you but as a patient and retired nurse my experience is that the insurance companies drive the bus 😢 I hate to hear the words “prior approval” or “ standard of care”

Who was that clown making the initial remarks, something tells me he couldn’t diagnose diarrhea.

... It's called professionalism informed by a constructive feed back loop ; screw the click baiting simpletons.

I would argue that, if anything, the use of guidelines prevents doctors from being used as "Useful idiots" like the video says. Our medical education system is just not designed to recruit the best critical thinkers, nor does it encourage critical thinking until at least the 2nd half of med school, if not the start of residency. So it's very easy for aspiring doctors to fall into the idea of cookbook medicine like you say, just focusing on memorization over actual comprehension. This has gotten substantially worse with Step 1 being Pass/Fail and the development of more rote memorization tools like Anki.

The framework is something you are meant not to question. You don't need to follow the recipe exactly to make the wrong thing happen. For instance, giving a gene therapy that has no long-term safety data on it that was manufactured by a company that has been in huge lawsuits for falsifying clinical trial data, and where the manufacturer is also shielded from all liability. Or discouraging treatments that actually work in favor of one that makes your lungs collapse. It has been proven that doctors who are paid on commission from drug companies will try to justify the decision that makes them money and it skews their treatment decisions significantly, since this kind of thinking happens with everyone (the initial experiment was very generic). So yes, almost anyone can be a useful idiot, especially ones who have to follow lots of rules and guidelines made by others, and it takes a fair amount of effort not to be one.

Doctors cannot take experimental risks with the health of their patients. Human beings are extraordinarily complex beings and it takes an enormous amount of research to make sure that treatment will be successful but is not going to inadvertently cause harm. Doctors do not have the resources to investigate ideas they may have and must err on the side of caution. As someone with Lupus, I am often frustrated by my medical care, but understand that doctors are relying on a huge body of knowledge amassed over many years and that can change rapidly. No individual should be able to discount that knowledge because they think they might know better. However, their expertise in knowing when and what treatments to use, rather than just ticking boxes is why they need so much initial and ongoing training The vast majority of doctors are dedicated, hard working professionals that have had to, basically, go through hell for their qualifications. Their workload would bury most of us. Any problems in medical care do not come from them, who are just as pissed off about the corporatisation of health care.

Go on his show and have a discussion. And I call BS on “evidence based medicine”… It’s funny how research gets left out from treatment options when there’s no money to be made.

Yes they are.

Doctors get paid whether they fix the problem or not. they even get paid if they make the problem worse. we treat them like they're gods.

To people who have such negative connotations against doctors, pls don’t come seek medical help or go to the hospitals. We’re already overwhelmed. Thank you

The Alfentanyl epidemic in the US raises some really awkward questions about medical practice in the US. I know that medicine is complex but for very obvious reasons Alfentanyl is VERY heavily regulated throughout the rest of the developed world, it's widespread and inappropriate use in America is either a result of a lack of intelligence or a lack of integrity.

I think you should look more to those doctors working with urban Medicaid patients to find the useful idiots mindset. However I don't believe it's to be a corporate shill but moreso out of the numbness that comes from ANY job that requires overworked/overbooked staff 365 days a year.

You make some good points. But Dr. Dhand sounds more knowledgeable about what is happening with medicine. You say "Practicing medicine is becoming more difficult and complicated by the day" - would you agree that there is an increase in Fear, Uncertainty and Doubt in the practice of medicine? Instead of feeling wounded by his 'useful idiots' rhetoric and focusing on that alone, maybe listen to the detail more?

The bigger issue is that not all docs are up to date with the best current practices. Case in point, some docs don't use paxlovid.

Do you ever teach to patients how to effect their health by food, before prescribing a kosher "medicine" for them?

Are there problems with the medical system as it currently exists, both in and outside the US? Sure. It's only fairly recently that we started acknowledging that the most common signs of a heart attack are different in women compared to men, for example (and still are weak on educating the public, at least, on what heart attacks can manifest like for women), even before the profit interests which hurt both medical staff and patients that Dr Glockenflecken has a lot of excellent comedic videos about. But... When someone. as the person you're responding to, suggests that using medicine is a bad thing (as implied by the criticism of the pharmaceutical industry in this context - not criticising it for the problems, such as jacking up prices of insulin and what have you, but seemingly the existence of pharmaceuticals) I do wind up wondering 'is this pro-snake oil - be that homeopathy, 'alternative medicine' supplements, or bleach enemas - or anti-vax, be that modern Covid flavour or classic Andrew Wakefield flavour?' Or, of course, the person could merely be a useful idiot - to borrow a phrase - for such scams and/or conspiracies.

Im amazed by some of my otherwise intelligent and educated friends who would rather take any weird potion or herb from a market stall than thoroughly tested medications with a well trained doctor prescribing it after a consult and another trained professional selling it to provide further advice. The love of anything but the doctor is a worrying phenomenon

This video doesn't even properly respond to the original. It's kind of a deflection.

I don't know about useful idiots, however, I have watched so many youtubers here struggle with diseases like cancer. I will tell you one thing, patients, like a current youtuber that is dying from lung cancer, should not be in this position because doctors REFUSED to give her the test she asked for. Pardon me, tests that she BEGGED for. There is another youtuber that talked about how she went to the hospital because she was bleeding and the ER doctor didn't even SEE her.... She was seen by a Nurse practitioner and was told it was stress!? STRESS? how does bleeding during a bowel movement translate into stress? That youtuber had to follow up and push for the necessary tests. SHOULD NEVER HAPPEN. She ended up having surgery that removed half her bowel and her uterus as well. Both of these youtubers are in their 30's. So I don't care if protocols suggest that it can't happen to someone so young... it can and it does. So make sure to do what the patient asks! If they're nervous about having a serious illness, then ease their minds. Don't just send them home with a medication. ...because of protocol.. It's heartbreaking to watch this young youtuber knowing she is going to leave behind a husband and two young children. She knew something was wrong and I can't believe she had to fight so hard just to get a scan. Just do the damn scan if that's what the patient wants... why did she have to beg for it? I don't know if it would've changed her outcome but jeez... just do it! I also know someone personally that died of lung cancer. Doctor kept saying she just had a bad chest cold and refused to do an x-ray because it wasn't necessary as far as he was concerned. She died two months later because the cancer was aggressive and spread quickly. Maybe that would've been her outcome anyway but maybe she could've been given more time with her family. Even if more time translates into just one extra hour. Don't take this personally, it's not against you but I wouldn't go out on a limb for all doctors. There are some really terrible ones out there that misdiagnose people left and right. As is evidenced by the people who share their journeys here on youtube.