Some of this is driven by the fear of litigation. If you "step outside the box", litigation seems more likely. It also, in Canada, is driven by the pressure of work, too many patients too few doctors, and the fact that there is a concrete fee schedule which punishes creative thought because it takes much more time. A physician who tries to be a compleat physician (I think that was said by John Donne) is punished compared to the physician who does the "best fit approximation" with the "usually prescribed medication". I fear that all too much of clinical medicine is driven by the monetary interests of insurance companies, and the not so subtle pressure of the pharmaceutical industry which also sponsors medical education seminars. This is also a failing on our part as physicians to place the welfare of the patient ahead of all other concerns. The business model has no place in the physician's consulting room, but it has clawed its way in like a legion of angry demons.

__________________
George Neeson M.D.