Fascinating critique of the medical profession. Thanks for posting this.

I don't think this is a critique at all -- it's kind of obvious and stupid, really.

Look, in any profession it's a statistical fact that half of those practicing it will be below average. This doesn't change the fact that medicine is the hardest profession to get into, academically and in terms of training. Doctors take the toughest science classes as undergraduates, go through four years of medical school, and spend at least another decade as medical interns, residents, and then doing fellowships if they want to specialize (which almost everyone needs to do now). It's also the hardest profession in the world with the most at stake, so of course mistakes are made that we should try to avoid.

The quote you excerpt about the bell curve is misleading and would lead readers to think physicians are below average in intelligence ("the bell curve," which is a term almost exclusive to the debate over general intelligence) compared to the rest of the population. That would be a huge misreading. You cannot survive as a practicing physician with below-average intelligence or likely even average intelligence: the academic and professional demands of such a highly technical profession would make it impossible for you to be admitted to medical school, much less graduate, much less survive the grueling process of being a resident, much less obtain a job with your training, much less pass the constant licensing board exams, all of which require you to memorize and apply so much information about the human body, the thousands of diseases and diagnoses it's subject to, and the thousands of techniques and procedures you have to master in order to be even the worst doctor in the nation. Psychological studies have consistently shown, in fact, that physicians and university professors have (by far and by a clear margin) a near-tie for the highest mean IQ of any professions in the nation. This hasn't changed for quite a while and I don't expect it to because we put those who are interested in these professions through such rigorous processes for gaining the right to practice their professions.

If you're reading this, you likely could not be and are not a physician, save that Bookofjoe guy. And that's a good thing, because we should trust the smartest and brightest with our most important and ethically demanding profession. This doesn't mean we shouldn't do our research and demand the best care, as so-called "consumer exposes" like this one point out. Of course some doctors are more experienced and more patient than others and of course there are lots of fundamental problems with our health care system that doctors too are frustrated with. But the fact that doctors perform such a valuable function in our society (perhaps THE most critical) shouldn't be forgotten amidst cheap shots about being "below the bell curve."

That is all.

A friend of mine once told me that his father was fond of saying, "Don't forget son, 50% of doctors graduated in in the bottom half of their class."

It's kind of a joke, I think.

As Booey says, "average" is relative to the sample.

BTW, I can't read the New Yorker article. I just get a solid dark grey page.

Okie doke, thanks to bookofjoe, I was finally able to read the New Yorker article, which is not exactly talking about what I was talking about. For one thing, it's talking about significant differences in outcomes for treatment of life-threatening/terminal illnesses, like cystic fibrosis. Differences that have the best CF treatment center in the country with patients that live, on average, 16 or so years longer than centers that are average. That's a HUGE difference in outcome.

So the biggest problem that the article points out is that doctors/hospitals are reluctant to have their "rankings" publicized. So how is a patient to know whether or not s/he's really getting the best care, particularly when it matters the most? You have to go with reputation, but as the article points out, reputation is typically not backed up with actual data.

worth mentioning is that statistics such as these are descriptive rather than predictive - and given that medicine is science and art, there are many more variables than group statistics

Doctors take the toughest science classes as undergraduates...

Actually no. Most pre-meds at my university fulfilled their hard science prerequisites by taking courses geared toward life science majors so they could avoid all the math. Of course, just the presence of pre-meds tended to make those courses more competitive, but conceptually they were generally pretty easy.

I agree with the above criticisms. People who don't understand statistics may be alarmed by data about the best and worst doctors in the nation. However, the rules of statistics demand that SOMEONE must be the worst. If all doctors in the bottom half of the bell curve quit tomorrow, we would just be left with a new bell curve, and 50% of doctors would still be "below average." Simply comparing doctors to each other is pointless.

right, we shouldn't grade them on the curve

Well, part of the point of the article was that patients can't really compare doctors in any meaningful way, which they should be able to do. One example given was the rate of post-surgical complications for a given doctor or the length of recovery time for a particular routine surgery for a particular doctor.

But most important was the hugely signficant difference in the life expectancy of people with cystic fibrosis. I'm sorry, but a 16-year differential just can't be ignored. And the scenario presented was that families were told they were getting the best care available at one center, by sheer word of mouth reputation, when another one had people living 16 years longer! There was no way for the patients [in this case, mostly the parents of children who were the patients] to compare one center with another.

You really need to read the article, if you haven't.