Cough up - I'm a doctor

From the outside looking in, medical diagnosis seems to be a diffuse but strongly hierarchical and mystique-ridden  process. My recent hospital stay involved a number of strands coming together to a final diagnosis, but who made the diagnosis and who gets most credit? Well no single person made the diagnosis and credit seems to be siphoned off by the most powerful as it would be in any hierarchy. 

1. I self-diagnosed a urinary issue, which took me to my GP.
2. My GP arranged a blood test and ultrasound scan.
3. The sonographer scanned my bladder and advised my GP.
4. The blood test results were returned from the lab to my GP.
5. My GP consulted the urology department at Derby Royal.
6. I given an urgent hospital admission.
7. A hospital registrar assessed my prostate as small.
8. The consultant came up with a final diagnosis and treatment plan.

Steps 1 to 8 involved six doctors and one sonographer or almost one medical diagnosis professional per process step. I should add that although not doctors, sonographers do medical diagnosis.

I'm not privy to the various brief conversations, notes and views through which these seven people made their  contribution, but as far as I can see, the final diagnosis had taken shape by step 5 and confirmed by step 7, before the consultant settled on treatment in step 8.

It was the hierarchical system we are all familiar with, where those higher up extract more from the process than those lower down without necessarily making a more significant contribution. I’ve no problem with that if genuine expertise is involved, because it’s how the world works, but I wonder to what degree medical diagnosis is designed to maintain the professional mystique and thereby pad costs.

There is also another issue that niggles away at me, because I find the structure of medical diagnosis interesting, and that is the question of automation. How much of the diagnosis depended on routine tests, such as the blood tests? Also, how much depended on the skill and experience of the sonographer, the person who diagnoses but isn't a doctor? From various clues I suspect the sonographer had a major impact in terms of technical skill and experience and also in diagnostic influence.

How much padding is there in all this? A hell of a lot I suspect. I've had a very good outcome so far, but it all felt heavily gold-plated.

Doctors should tread carefully when considering strike action. Their diagnostic skills are heavily bolstered by technical input and it is not at all clear what they uniquely contribute or how costs and mystique are unduly inflated by their hierarchical approach.

I've had a very good result so far and a potentially very serious outcome seems to have been averted. So at that personal level I'm very satisfied and genuinely grateful - but not pathetically grateful. The process feels antiquated and self-serving to me.