Why Doctors So Often Get It Wrong - New York Times

The premise of this article seems to be that if given enough money, doctors and hospitals would misdiagnosis less...Most doctors I know operate on a much higher plane than skinnerian rats pressing a lever for economic reward.Most doctors I know are obsessive compulsive neurotics, instinctive and bright ruminators, over achievers, and most of all, humanitarians who take pride, in making correct diagnoses and delivering appropriate treament. Now hospitals...that's another matter...
Why Doctors So Often Get It Wrong - New York Times: "With all the tools available to modern medicine — the blood tests and M.R.I.'s and endoscopes — you might think that misdiagnosis has become a rare thing. But you would be wrong. Studies of autopsies have shown that doctors seriously misdiagnose fatal illnesses about 20 percent of the time. So millions of patients are being treated for the wrong disease.

As shocking as that is, the more astonishing fact may be that the rate has not really changed since the 1930's. 'No improvement!' was how an article in the normally exclamation-free Journal of the American Medical Association summarized the situation.

This is the richest country in the world — one where one-seventh of the economy is devoted to health care — and yet misdiagnosis is killing thousands of Americans every year.

How can this be happening? And how is it not a source of national outrage?

A BIG part of the answer is that all of the other medical progress we have made has distracted us from the misdiagnosis crisis."...

But we still could be doing a lot better. Under the current medical system, doctors, nurses, lab technicians and hospital executives are not actually paid to come up with the right diagnosis. They are paid to perform tests and to do surgery and to dispense drugs.

There is no bonus for curing someone and no penalty for failing, except when the mistakes rise to the level of malpractice. So even though doctors can have the best intentions, they have little economic incentive to spend time double-checking their instincts, and hospitals have little incentive to give them the tools to do so.