80/10/10
Truth Bomb …. Incoming.
Like Slim Pickens pictured above (from Dr. Strangelove, or How I Learned to Love the Bomb) I have a truth that is unpleasant to drop.
The truth is (and I admit that this truth applies to the office based care types out there, it does not hold for surgeons) that we are just not that important.
Any self-respecting medical school graduate is familiar with the 80\20 rule. Any question offered to you – if the answer is likely to be higher in likelihood say 80% and if less likely say 20%. It is staggering how close to the truth you will be. I will offer a variation of that rule – the 80/10/10.
What percentage of our patients are going to get better and be pretty much fine without us? They weren’t going to die from that uti, or that sore throat. They would get better, but we ease the passage and prevent complications that would be more serious. But overall, that depressed patient was not likely to kill themselves, they would get better on their own. This number is a solid 80%
What percentage of patients are going to get worse and not do well despite our best efforts? The diabetic heading to a heart attack, the cancer patient, the suicides? Sadly, this is a solid 10%.
Here is the big one – what percentage of patients are going to do horribly and have horrible outcomes with debility, disability, and death ensuing – but with our care will do fine? What number is it that we make enormous differences in out patient’s lives? It’s a solid 10%.
So, in reality, we train, journal read, CME, did the med school and residency, all our lives are really for the 10%. And I readily admit that those are the ones that keep us going day to day. I also admit that this truth bomb is behind the independent practice of medicine movement.
They say that nurse practitioners and PAs have similar outcomes to physicians. They are right. About 90% right. 80% get better, 10% don’t, and the other 10% often get frustrated and go to a real provider. Pretty similar numbers. And they didn’t have to give their entire life for medicine.
I agreed until almost the end. I will not be called a Provider. It’s a word that has been put out there to blur the lines.
Agree. I am in GME and it is appalling how my residents have been indoctrinated into calling themselves providers!
We had a professor who objected to describing our residency as “training”. He said “you can train a monkey.(Real helpful for our self-esteem) We are trying to educate you residents to get that 10% (or 5% or 20%) that the monkey can’t get right”.
Your basic tenet, I think, is true. As patient, when you fall into that small percentage, you are awfully glad you saw the doctor. You just don’t know when that will be
Excellent point – exactly – and made more true by the split between in hospital internists and out of hospital internists.
“They say that nurse practitioners and PAs have similar outcomes to physicians. They are right.” This is untrue. See https://authenticmedicine.com/2022/04/the-hattiesburg-study-an-unsurprising-surprise/ by Dr. Natalie Newman,
Well I can’t compete with research. I deal mostly in cantankerous bluster. But I would also argue the 80 10 10 applies to the scores of acute care clinics that have sprung up all over. Although mostly staffed with midlevels they have the occasional md or do. Far too busy to pick up any symptoms that indicate the treatable 10.
The study you reference simply proves that physicians are still respected by patients and that we are better equipped (i.e. trained) to convince patients they should get these preventative services. He is dead on with the his rule and honestly I think it is more like 90/5/5. This is why it can be very easy to show that physicians and APP have similar outcomes depending on how you massage the data. When I explain to patients that a physician’s training is so much longer than a APP in order to detect a serious life threatening condition that on the surface may seem like something that is common and non-life threatening, they totally get it.