I'm sure many doctors do as you describe, but in my experience, most specialists physicians don't fall into that trap. They will prescribe "un-proven" and un-approved treatments if they think the risk-benefit relationship is favorable. However, it takes significantly more knowledge about the disease, your specific patient, and all the latest research to make a decision like that. Furthermore, if you're wrong, it's your hide on the line. If your family doctor knows all that, then they're a specialist.
The cost of treatment/no treatment: I'm going to disagree with you strongly there. That's drilled into our head every day in school. The cost to the patient, the cost to society, the side-effects the patient experiences, the risk of serious adverse reactions, the risk of going without treatment, the chance that the treatment doesn't even work at all (in the case of the unproven treatments)... we talk about this almost every day.
So, agreed: "Not proven beyond a wide margin of error" is not the same as "no evidence", however I don't think many doctors believe that. That is, it's not a flaw of rationality - it is either a convenience thing, a lawsuit thing, or most often limits to the doctor's knowledge.
I'm sure many doctors do as you describe, but in my experience, most specialists physicians don't fall into that trap.
Specialists are a mixed bag. Some will think. Others will have their hammer, and every problem will be a nail on a conveyor belt. So some may be more adventurous, but I haven't met any who seemed to have a decent grasp of statistics or decision theory.
Furthermore, if you're wrong, it's your hide on the line.
Yes. Everyone involved, from payers to regulators to manufacturers to care institutions to care providers to patients protect t...
Today I Learned in Medical School:
Doctors have medical myths too! According to my prof, many doctors believe that aspiration (having stuff go down into the lungs) causes anaerobic pneumonia, but that is rarely the case. He says that myth is often taught resident-to-student, but it isn’t actually backed up by any research, and isn’t true. The kicker - if the doctor would stop to think about it, it should jump out as unintuitive – it would take some serious changes inside the *lung* to make an *anaerobic* infection – an infection of bacteria that thrive in areas with no oxygen. In reality it takes frequent aspirations over a long period of time to block off an area of the lungs.
I think the moral of this story (though this just may be preaching to the choir here at LW) – all people, be they doctors or kindergarteners, don’t usually check facts they’re taught, especially when being taught by an authoritative teacher. Unless they’re lead to discover/derive a fact themselves, they usually assimilate it into their network of beliefs as a brute fact – “carbon has four valence electrons,” “don’t end a sentence with a preposition,” “in 1492 Columbus discovered America.”
Now, you frequently don’t have enough time to “learn it the hard way” or derive an answer yourself. If I had to read every single research publication that populated the facts in my textbooks, I might not ever graduate. However, it is important to remember that you’ve taken shortcuts for most of your education (and religion/lack thereof, and life in general) – and if some fact ever later strikes you as being odd, look into it. Otherwise, we’re just playing the telephone game.