Because We've Always Done It That Way

There's a phrase in medicine that has driven me crazy since I was a medical student, through residency, and now as a faculty physician.

Here's how it goes: I'm confused about why we are doing something in medicine. So I ask an expert why we do it. And the answer is often: "Well, we've always done it this way." That is not an acceptable answer.

For generations, we took out kids' tonsils whenever they had recurrent sore throats or ear infections. The surgical risks were real. The benefits were often negligible. Why did we do it? Because we'd always done it that way.

For generations, we told people with bad backs, heart attacks, and even pregnancy complications to rest in bed. It seemed intuitive. But when researchers actually studied it, they found that bed rest often made things worse — muscle wasting, blood clots, depression, and delayed recovery. Why did we do it? Because we'd always done it that way.

Here’s another example. Episiotomy — a surgical cut to widen the birth canal during delivery — became standard practice in the 1920s. Not because of strong evidence, but because an influential physician promoted it while establishing obstetrics as a new specialty. For decades, almost nobody questioned it. Then, a doctor named Michael Klein, who died last month, spent much of his career trying to prove that this common procedure caused more harm than good. He was told, again and again, that episiotomies were simply how it was done.

Here's an even crazier example. In the 1840s, Ignaz Semmelweis showed that doctors washing their hands between autopsies and childbirth dramatically reduced maternal deaths. For this, he was ridiculed and locked up for years until he died in what was then called an insane asylum. It took decades — and the discovery of germ theory — before handwashing became standard.

But sometimes the problem isn't habit. Sometimes it's logic that seems too obvious to test. After a heart attack, patients often develop irregular heart rhythms that can cause sudden death. So doctors reasoned: suppress the rhythm, save the patient. It made perfect sense. But when researchers finally studied it — looking past the heart monitor to the actual patients — they found the drugs were killing people, as many as fifty thousand Americans a year.

The lesson isn't that doctors are careless. It's that something can become standard practice simply because it seems to make sense — but this is before anyone tests whether it actually works. Suppressing dangerous rhythms should save lives. Resting should help you heal. Widening the birth canal should ease childbirth. The logic feels so obvious that testing seems unnecessary.

So it's reasonable — even healthy — for you to ask your doctor a simple question: Is this based on solid evidence, or is it just how we've always done it? Those are not the same thing.

Being an informed patient doesn't mean distrusting your doctor. It means understanding that medicine is a human enterprise — shaped by history, culture, and habit, not just pure science.

— Dr. Michael Wilkes with a Second Opinion

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