Why do doctors continue to do the wrong things ?

When I tell patients who have been treated with a toxic and useless 9 month course of antiTB medicines ( because their endometrium was PCR positive for TB ) that they have received poor quality treatment, they get very frustrated. Their commonest complaint is - Why did my doctor provide me with the wrong treatment ?

Here are some possible answers !

‘We [doctors] do things, because other doctors do so and we don’t want to be different, so we do so; or because we were taught so [by teachers, fellows and residents (junior doctors)]; or because we were forced [by teachers, administrators, regulators, guideline developers] to do so, and think that we must do so; or because patient wants so, and we think we should do so; or because of more incentives [unnecessary tests (especially by procedure oriented physicians) and visits], we think we should do so; or because of the fear [by the legal system, audits] we feel that we should do so [so-called ‘covering oneself’]; or because we need some time [to let nature take its course], so we do so; finally and more commonly, that we have to do something [justification] and we fail to apply common sense, so we do so.’

Parmar MS. We do things because (rapid response). BMJ. Posted 1 March 2004 at www.bmj.com.