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Table 4 Five domains of change in the current practice of medicine, and their potential adverse consequences**. Fourth domain: expanding knowledge

From: The Spectrum of Harm Associated with Modern Medicine

↑ Time required to tailor diagnosis/treatment to the unique individual—↑ options for tests and treatments beget harder decisions ; ↑ Biased inferences by drugs and devices industries: ↑ potential of skewed recommendations; ↑ guidelines to follow (some contradictory); ↓ Constancy—goals and methods keep changing: a “moving target”; ↑ Role of evidence-based medicine: downplaying individual experience and clinical judgment; ↑ Specialization and mandatory sub-sub-specialties; ↑ fragmentation of care; ↓ Impaired transitions of care (“handoffs”); ↓ Control; ↓ Accountability; ↓ Confidence; ↑ Risk of errors; ↑ Readmissions
  1. **Reported for every discipline (primarily, family medicine and general internal medicine) and setting, including hospital admissions. Domains’ effects are interwoven with each other. All contribute together to the “crisis,” “collapse,” or “chaos” (quotes) in current health-care systems