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Quixotic Medicine: Physical and Economic Laws Perilously Disregarded in Health Care and Medical Education

Haburchak, David R. MD; Mitchell, Bradford C. MD; Boomer, Craig J.

Academic Medicine:
doi: 10.1097/ACM.0b013e31818c65c0
Philosophy of Medical Practice

Wise medical practice requires balancing the idealistic goals of medicine with the physical and economic realities of their application. Clinicians should know and employ the rules, maxims, and heuristics that summarize these goals and constraints.

There has been little formal study of rules or laws pertaining to therapeutics and prognosis, so the authors postulate four physical and four economic laws that apply to health care: the laws of (1) finitude, (2) inertia, (3) entropy, and (4) the uncertainty principle; and the laws of (5) diminishing returns, (6) unintended consequences, (7) distribution, and (8) economizing. These laws manifest themselves in the absence of health, the pathogenesis of disease, prognosis, and the behaviors of participants in the health care enterprise. Physicians and the public perilously disregard these laws, frequently producing misdiagnoses, distraction, false expectations, unanticipated and undesirable outcomes, inequitable distribution of scarce resources, distrust, and cynicism: in short, quixotic medicine. The origins and public reinforcement of quixotic medicine make it deaf to calls for pragmatism. To achieve the Accreditation Council of Graduate Medical Education competency of systems-based practice, the authors recommend that premedical education return to a broader liberal arts curriculum and that medical education and training foster didactic and experiential knowledge of these eight laws.

Author Information

Dr. Haburchak is professor of medicine and program director, Internal Medicine Residency Training Program, Department of Medicine, Medical College of Georgia, Augusta, Georgia.

Dr. Mitchell is a recent graduate of the Medical College of Georgia and is currently serving as a resident in diagnostic radiology at Emory University School of Medicine, Atlanta, Georgia.

Mr. Boomer is a recent graduate of the School of Economics, Georgia Institute of Technology, Atlanta, Georgia, and is currently a financial analyst in Atlanta.

Correspondence should be addressed to Dr. Haburchak, Medical College of Georgia, 1120 15th Street, BA 5305, Augusta, GA 30912; e-mail: (

© 2008 Association of American Medical Colleges