Cowboy Doctors

Cowboy doctors’, a term first popularized by surgeon and New Yorker writer Atul Gawande, are doctors who push boundaries and guidelines, provide daring and often unnecessary treatments, and act alone.

Gawande’s original New Yorker article discussed the problems of disjointed hospital staffs. Over 15 staff members are involved in the care of each patient, but each seems to act alone giving rise to lapses in protocol, high infection rates, and negligent errors. Cowboy doctors often provide extreme and excessive care to critically ill patients and persuade their patients that these unnecessary additional medical procedures offer a chance of recovery, though clinical guidelines disagree.

A 2015 study by Harvard professors found that the practices of cowboy doctors are costing the United States 2% of the entire Gross Domestic Product.

The Harvard study provided physicians with scenarios and offered a number of choices for care. One scenario focused on an 85 year old male patient with severe congestive heart failure from coronary artery disease. The scenario provided a number of clinical characteristics of the patient (is taking the maximum amount of medications, is not a candidate for bypass surgery) and provided doctors with a number of treatment options to choose from.

While clinical guidelines advise doctors facing this patient to discuss end of life options and palliative care (care focused only on the relief of symptoms and making the patient more comfortable), the study instead found that 25% of cardiologists and 22% of primary care physicians would choose aggressive treatment options.

These more aggressive treatments were not supported by clinical trials and evidence, had strong potential to make the patient worse, and dramatically increased healthcare spending.

Though these doctors believe that they were offering their patient one big change to recover, they may do more harm than good.

Patients who find significant clinical advice online that conflicts with their own doctor’s advice should be wary of agreeing to substantial and costly medical procedures. Patients want to trust that their doctor is doing everything possible to help them, but may not expect that doctors can also go too far.

Another considerable problem with cowboy doctors is the amount of money they cost healthcare companies. If cowboy doctors cost the U.S. 2% of its GDP every year, the 2014 cost would be $358.8 billion. The study found that costs associated with cowboy doctors accounted for 35% of end-of-life Medicare expenses, 12% of overall Medicare expenses, and 17% of all U.S. healthcare spending.

Many people have blamed medical malpractice cases for rising health care costs, though studies have found this to be untrue. One explanation for these rising costs could be a growing number of cowboy doctors.

The Harvard study reports that “movements are underway” to shift the healthcare system to rewarding benefits for the patients over attempted treatments. Patients should feel comfortable expressing their concerns and preferences with their doctor and knowing they will be considered. Medical decisions are not for doctors alone.