Is your doctor a quack?


Why Your Doctor Has No Obligation of Result

Doctors often do a good job. Nevertheless, they also make mistakes—sometimes serious ones. Now, mistakes can be made in any profession, but there are some disconcerting issues at play in the medical profession that can lead to an entirely wrong approach. They can make your physician a quack against their will. And that carries risks for both you and your family. Here you can read about the scientific basis for your doctor’s treatments and why his legal situation MUST be different. Let’s start with the latter first.

By C.F. van der Horst
August 9, 2015, updated October 21 2022

No Obligation of Result but of Means

Legally, a peculiar situation exists. Unlike most professions, a physician does not have an obligation of result but an obligation of means. In the former, one is legally obligated to realize a tangible end result. In the latter, this is not an issue at all. It involves providing services with no requirement to achieve a specific end result.

An article published by NEVI (Dutch Association for Purchasing Management) describes a doctor’s legal situation particularly well: “An important distinction in contracts is that between the obligation of result and of means. An obligation of result is one in which the debtor promises to deliver a ‘measurable’ result. In an obligation of result, a certain result is required, as, for example, in purchase agreements and in contracting work. An obligation of means is an obligation whereby the obligor commits to make an effort to fulfill his agreement. In an obligation of means, the obligor is required to take sufficient care to achieve the agreed result. The mere fact that the desired result is not achieved does not automatically constitute a default. In the case of liberal professions, such as doctors and lawyers, there is usually an obligation of means.”

Doctor’s Treatment Offers No Guarantees

Simply put, a physician will strive for the best possible outcome without precisely defining or committing to that outcome. This legal situation indicates that, by definition, your visit to your doctor has no guarantees. It is this situation that brought a bitter saying into the world: “The operation was a success, but the patient died.”

Doctor with child-is he a quack against his will?@2x

Is your doctor a quack willy-nilly?

Therefore, it is important to be critical of your medic. A vivid lady in her old age was very smart when she said: “I am my own doctor and my family physician is my medical advisor.”

Little Proven Benefit: Quackery

The obligation of means arose from the fact that there are few certainties in medical treatment. The doctor’s lack of adequate knowledge makes an obligation of result impossible. For example, the scientific basis for the majority of medical treatments is questionable. Just how bad is it? One of the leading medical journals, the British Medical Journal (The BMJ), maintained a database called BMJ Clinical Evidence for many years (until 2017). This Evidence-Based Medicine (EBM) database showed the best available evidence of standard clinical treatments.

The figures through 2017 are shocking: of the 3,000 medical procedures examined, only 11% have demonstrated efficacy. 24% of them are believed to work ‘probably.’. The rest range from inconclusive to harmful. The benefit of 50% of the treatments has never been studied. All things considered, if we give the 24% the benefit of the doubt, a doctor who chooses an intervention from the remaining 65% is nothing more than a quack. And there are no signs of improvement. Indeed, the percentage of treatments with proven benefit is worsening. For example, in 2010, the Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine) published an article on BMJ Clinical Evidence showing that the percentage of treatments with unequivocally demonstrated efficacy was 13%.

Number of Chronically Ill Doubled in a Decade

And it is not only treatment where a doctor’s knowledge falls short: prevention also leaves much to be desired. According to the Dutch National Institute of Public Health and the Environment (RIVM) is increasing the number of chronically ill people: “Over the past 8 years, the number of people with one or more chronic diseases has increased by 17%. In 2011, a total of 5.3 million Dutch people had a chronic disease. Chronic diseases are especially common among the elderly. However, the increase in recent years is visible within all age groups. At 26%, the number of people with multimorbidity has risen even faster. Multimorbidity occurs when a person has more than one chronic disease during a given period. A total of 1.9 million Dutch people have multimorbidity. There are also indications internationally that multimorbidity is on the rise.”

On January 1, 2016, there were 8.8 million people with one or more chronic conditions, exactly two years later there were 9.9 million and on January 1, 2021 there were 10.3 million. In just 9 years, the number of people with chronic illnesses has doubled. What does that say about the state of medicine?

GP Hans van der Linde is critical of training and continuing education of doctors@2x

General practitioner Hans van der Linde is critical of training and continuing education of doctors

Medical School and Continuing Medical Education Inadequate

Although the majority of doctors work in good conscience, neither medical school nor continuing medical education is up to the task. In an interview, general practitioner and columnist Hans van der Linde of Capelle aan den IJssel, a member of the College Accreditation of General Practitioners for 10 years, referred to today’s medical training as “Exceptionally bad.” In the daily newspaper Trouw he reported on continuing medical education, “The Dutch general practitioner is obliged to undergo continuing medical education under penalty of being stripped of his registration as a general practitioner. In the absence of sufficient independent continuing medical education, general practitioners are by necessity taking continuing medical education from the pharmaceutical industry en masse. That one uses continuing medical education as a marketing tool. This influence can lead to incorrect and unnecessarily expensive prescribing behavior [nadruk toegevoegd]. The actual situation is that the system of re-registration forces family physicians to take industry courses.”

"Deadly Lies. How Doctors and Patients Are Deceived" describes the conflicts of interest of government officials and scientists, the mass marketing of the pharmaceutical industry, and the lies used to deceive both physicians and you.

“Deadly Lies. How Doctors and Patients Are Deceived” describes the conflicts of interest of government officials and scientists, the mass marketing of the pharmaceutical industry, and the lies used to deceive both physicians and you.

How effective regular medical treatments are and what impact they have on public health is covered in detail in Deadly Lies: How Doctors and Patients Are Deceived.

Is Your Doctor a Quack?

A physician who routinely treats or prescribes without scientific justification is, by definition, a quack (see Mainstream Quackery). The same goes for doctors who prescribe repeat prescriptions without investigating what can be done about the underlying causes so that long-term use of medication (always with side effects!) is no longer necessary.

As a patient, you are served by information about what are good and bad forms of therapy, but even more so about what you can do to keep yourself healthy. The book Deadly Lies: How Doctors and Patients Are Deceived provides you with this knowledge. It will help you in disease prevention and in recognizing a quack.

Want to know more?

What does a physician learn in medical school? What does or doesn’t he know? What happens in his continuing medical education? How can YOU determine whether your doctor is or isn’t a quack?

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Copyright © 2015, 2022 C.F. van der Horst, Per Veritatem Vis. All rights reserved.

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