“What’s Wrong With You?”

Don’t get sick anywhere but at home:

…doctors in Tanzania complete less than a quarter of the essential checklist for patients with classic symptoms of malaria, a disease that kills 63,000-96,000 Tanzanians each year.  The public-sector doctor in India asks one (and only one) question in the average interaction: "What’s wrong with you?".  In Paraguay, the amount of time a doctor spends with a patient has nothing to do with the severity of the patient’s illness…these isolated facts represent common patterns…three years of medical school in Tanzania result in only a 1 percentage point increase in the probability of a correct diagnosis…One concern with measuring doctor effort through direct observation is that the doctor may work harder in the presence of the research team.

That is from "The Quality of Medical Advice in Low-Income Countries," by Jishnu Das, Jeffrey Hammer, and Kenneth Leonard, in the Spring 2008 issue of the Journal of Economic Perspectives.  The editor is now Andrei Shleifer and this issue is one of the best in a long time.


"three years of medical school in Tanzania result in only a 1 percentage point increase in the probability of a correct diagnosis"

Geez, talk about a bad ratio of costs to benefits!

In 1996, my expensive doctor in Chicago told me the large swelling that had been in my armpit for months was "probably just a muscle pull. Don't worry about it."

It turned out to be a lymphoma tumor the size of a Polish sausage.

Anyway, the point is that the real world of diagnosis isn't like an episode of "House," where a surly genius and his hard-working acolytes drop everything to figure out what's wrong with you.

Jesus Crist comes to earth to work as a medical doctor.
The patient, in wheelchair enters . JC without seeing him, says get up and walk.He leaves walking. He is asked what the Doctor said.Nothing he didnt even ask me What's wrong with you?

I got some kind of infection in India. Went to my friend's uncle, who is a specialist in diseases of the skin. I felt that his treatment was the equal of anything I've received at home. Photos (not appropriate for mealtimes): http://flickr.com/photos/russnelson/sets/72157603794356820/

I must be misreading the report....

[In particular, the competence of doctors in low-income countries is low, the quality of care provided to
patients is even lower than would be suggested by a doctor’s competence and the poor have access to worse quality care than the rich, whether from the public or the private sector.]

Could this be because of the following?

[Dr. SM and his wife seem highly motivated to provide care to their patients and even with a very crowded consultation room they spend more time with their patients than a public sector doctor would. However, they are not bound by their knowledge of health care and instead deliver the health care, like the crushed pills in a paper packet, which will result in more patients willing to pay more for their services. Indeed, over-medication in India is a widespread (for instance, Greenhalgh, 1987; Phadke, 1998). Note, this is consumer driven and not “supplier induced demand† of practitioners exploiting asymmetric information to talk people into unnecessary treatment.]

That last sentence seems paradoxical, if not disingenuous, to me.


If you think that decreasing barriers to entry reduces the quality of health care, then presumably you think the increasing barriers to entry increases the quality of health care. It would follow that third world countries could increase the quality of their health care by introducing the kind of restrictions on doctoring that the U.S. has.

But that's clearly wrong, because introducing those kind of restrictions would result in there being even fewer doctors in already doctor-starved nations. (In the U.S., there are 600 persons/doctor; in Uganda, there are 18,000 persons/doctor.) Actually, it would result in black-market doctoring, because those governments don't have sufficient control of their countries to stop it, but for the sake of argument I'm assuming your policy could be successfully imposed by fiat.

As I argued above, I don't think that quality of doctors is a very important factor in health care, at least compared to factors like the quality of technology ahd treatments. But even if I did think that quality of doctors was an important factor, and increasing barriers to entry increases it, it would still be true that the availability of those doctors was also an important factor, and increaseing barriers to entry reduces it.

being a medical student in Tanzania is the best opportunity in life i've had, and one should never judge the whole country from experience they've had with one person out of the 35ml people country that Tanzania. personal homework on tropical diseases (which am sure are not covered well in medical schools in developed countries)read on Konzo disease to keep up with us;-)

Please come to shaiya gold, we will give you a great surprise.

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