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learning about our flawed cognition keeps us humble.
Even Kahneman, Nobel laureate and the founder of the heuristics and biases field, says at the end of his 400-page book Thinking Fast and Slow that after 30 years of study, he is no better at avoiding these biases than he was when he started. He says he may now recognise a few situations where he is at risk of making cognitive errors, but like all of us, he is still better at seeing them in other people than in himself.
This type of time-dependent bias afflicts observational studies. It's a particular curse for those studies relying on the "big data" from medical records instead of randomized trials. A recent study found close to 40% of susceptible studies in prominent medical journals were "biased upward by 10% or more".
All of a sudden, I didn’t care if he experienced nausea while eating that morning or was too weak to walk.
A recent survey reports that most of the physicians in this country have biases that may interfere with patient care. These biases can be in form of religion, race, ethnicity, personal values and may even stem from language barriers.
He said “Of course I have personal biases. It’s human nature to judge and be judged.”
We all have our opinions and prejudices, based on who we are, where we come from, what we have experienced, and how we have been taught.
To me, this is the great divide in the world today — not between liberal and conservative, rich and poor, or between any one race or creed and all the others, [but] between people who have the courage to listen and those who are convinced that they already know it all.
Instead of choosing to read or to listen only to the people whose views make you the most comfortable — which is becoming easier and easier to do — choose instead to study those who make you the most upset.
These principles include a commitment to justice, a belief in freedom, respect for the dignity of every human being, the capacity for forgiveness, and a desire to pursue the truth wherever that journey might lead.
Another time I was lying on the examining table when a gastroenterologist I was seeing for the first time looked at my list of drugs and shook her finger in my face. “You better get yourself together psychologically,” she said, “or your stomach is never going to get any better.”
If you met me, you’d never know I was mentally ill. In fact, I’ve gone through most of my adult life without anyone ever knowing — except when I’ve had to reveal it to a doctor. And that revelation changes everything.
At least 14 studies have shown that patients with a serious mental illness receive worse medical care than “normal” people.
clinicians are more likely to make errors of judgment when they're treating frustrating and difficult patients
The doctors also tended to recall more about the behaviors of difficult patients, forgetting their clinical histories.
Carl Olden, a family physician in Yakima, Wash., says patients with low health literacy can be difficult, as can those who have self-diagnosed either through the Internet or television advertising for a drug.
Interestingly, we realized these patients who are considered difficult by their provider actually adore their physician
Pre-visit questions include having the clinician consider their own potential biases, reflecting upon why the patient is difficult and articulating their agenda for the visit.
Focus objectively on the patient’s needs and best interests.
Treat all patients equally - function compassionately and free of preferences for some patients.
Do not expect patients to return kindnesses or to be thankful.
It is important to address a physician’s emotional reaction to a patient’s non-clinical behaviours. We recognize that, at times, physicians may have negative emotions, such as anger or frustration, towards patients. As professionals, we must try not to act on these thoughts and feelings in a hostile or destructive manner.
It is inappropriate to talk down to your patient in a condescending or overly paternalistic way.
Physicians that didn’t go into medicine to be defined by patient satisfaction surveys. Physicians that didn’t go into medicine expecting that people wouldn’t trust in their training because the Internet begs to differ. Physicians that cringe at the drive-through mentality that patients can present with diagnoses in hand and demands for tests to be done. Physicians that want out.
There's something that is really quite perfect for this thread ... & in more than one way ...
"Biologist talks to statistician"
[url]http://m.youtube.com/watch?v=Hz1fyhVOjr4[/url]
This really cracks me up, which I know is kind of weird being a SAHM and all ...but I did pretty good with biology & stats once upon a time ...
but what keeps popping in my mind is that we need some
"Google-mom talks to physician" cartoons, but not all written from the doc's point of view. :)
This is the way that 21st century patients learn and connect in a medically complicated world.
Access to information represents one of the earliest and most powerful forces redefining doctors and patients.
That mug/meme may seem like a silly, harmless joke. But, the message, and the sentiment behind it, is offensive and detrimental to the doctor-patient relationship.
The truth of the matter is that sometimes my Google searches come up with better treatment ideas than the doctor with the medical degree reviewing my case.
Just knowing about cognitive biases and the danger they pose to our own thinking, decisions, and actions doesn’t protect us.
Why are you agreeing with or dismissing this study, argument, or claim? Does it make you feel good? Vindicated? Indignant? Anxious? Your emotions might point to your biases.
“Hands up who’s not here!” I used to have a cardboard hand I’d hold up for this when I did advocacy training workshops. What and who is missing is always important.
Social media are part of the problem and the solution. The internet and social media offer a great opportunity for democratization of knowledge and information sharing.
On my time I want them to listen. I want them to utilize their skills and knowledge and work with me – not because it’s nice or kind – because it is their job.
As good scientists I want them to embrace the best knowledge we have at this time – and that would include awareness of their own cognitive biases.
In other words, a doctor, like anyone else who has to deal with human beings, each of them unique, cannot be a scientist; he is either, like the surgeon, a craftsman, or, like the physician and the psychologist, an artist.
something larger than aesthetic admiration for one another’s work — they are based, rather, on a certain resonant affinity for the spirit undergirding the work, of which the work is only a partial expression
I’ve read terrifying posts of parents asking Facebook for advice while their child was having an allergic reaction
@harriet75 I'm mortified by this. What drives someone to turn to Facebook when their child is having anaphylaxis?!? We have to do better.
@harriet75 thanks for the insight. I had no idea it was this bad. Guess I have a renewed sense of purpose. Good night - thanks!
@AllergyKidsDoc I know!!! My words call your dr ! Follow action get off Facebook!
@AllergyKidsDoc and to answer you question. Why. I did a poll in my group. It was surprising how many parents said they don Trust dr
The 140 character-or-less blurb omits months or even years of ongoing dialogue between patient and physician.
members of the medical community are trained specialists well-versed in offering advice without bias
Most patients and friends do not benefit from that experience, so how could we expect their anecdotal “evidence” offered via social media to be accurate?
She ended by writing, "I have seen countless neurologists, neurosurgeons, spinal specialists, etc., and so far, no one has been able to tell me what's wrong with me."
Because of all the comments from Imgur users who pointed out the similarities between Rose's symptoms and EDS, she went to a specialist and got tested. And on Wednesday morning, the results confirmed what so many Imgur users had suspected: Rose was born with the rare genetic condition.
This video illustrates a story I've heard from some #foodallergy families about disagreement in the ER
On the eve of the 15th anniversary of two seminal reports from the Institute of Medicine (IOM) – Crossing the Quality Chasm1 and Unequal Treatment2 – we find that racial and socioeconomic inequity persists in health care.
Implicit (subconscious) bias refers to the attitudes or stereotypes that affect our understanding, actions and decisions in an unconscious manner.13 These biases, which encompass both favorable and unfavorable assessments, are activated involuntarily and without an individual’s awareness or intentional control.
stereotypes and prejudices resist change, even when evidence fails to support them or points to the contrary
“This is the difference between really listening, and doing it the easy way,” Doty says. “If your patient feels rushed, if they feel you’re not really with them, or that they’re just another number, you won’t establish that trust you need to create a connection where your patient feels you truly care, and vice versa.”
In the case of medicine, it’s a disservice not to offer courses that focus on empathy, communication and relationships
The commodities I struggle to ration are my own time and emotional energy. Almost every day I see a patient like the woman with diarrhea and I find myself at a crossroads: Do I ask her what’s really bothering her and risk a time-consuming interaction? Or do I accept what she’s saying at face value and risk missing a chance to truly help her?
I sit at my workstation to document and bill for our encounter, perched at the edge of my seat, on the verge of despair.
Healthcare professionals have, in addition to their clinical authority, a moral authority and consciously (or more often not) and intentionally (or not) pass moral judgement on their patients’ behaviour if they do not acknowledge shame and self-blame.
Empathy does require us to try to understand them, what they did, and why, but does not demand that we like them.
Improper & "potentially proper" biases? Ioannidis argues for assessing psychotherapies in properly-biased studies journals.cambridge.org/action/display…
reflect implicit biases
reveal misconceptions
transmit negative attitudes to other providers
juxtaposing patient reports of pain with discrediting comments
Blaming a patient for their symptoms
University of California, Los Angeles, neuroscientist Antonio Damasio calls this the “high-reason view.” It assumes, he writes in his seminal book Descartes’ Error, that when people are at their decision-making best, that they’re the “pride and joy” of Plato, Rene Descartes, and Immanuel Kant, all of whom espoused a coolly computational mode. “An important aspect of the rationalist conception is that to obtain the best results, emotions must be kept out,” Damasio observes.
To make the right call, you need to feel your way — or at least part of your way — there.
Another trait that marks them is that they have high levels of both vulnerability and courage. As Martha Nussbaum wrote in her great book “Upheavals of Thought,” to be emotional is to attach yourself to something you value supremely but don’t fully control.
First, people with passion have the courage to dig down and play with their issues. We all have certain core concerns and tender spots that preoccupy us through life. Writers and artists may change styles over the course of their careers, but most of them are turning over the same few preoccupations in different ways.
Most people have heard how irritated many doctors get when patients are non-compliant. "Well," I said, hesitating, "I guess I just ask them why they aren't taking them. There's got to be a reason for it, and I try to figure out why. It could be that the prescription costs too much; it could be that they are afraid of side effects; it could be that they heard something bad, or have some other bias against the medication for a reason I don't know; or it could be that they just don't understand why I think they should be on it in the first place."
Many docs are far too quick to disbelieve symptoms the patient reports, and so many patients are afraid to tell of symptoms that "don't make sense." This can lead to mis-diagnosis.
Physicians can underestimate a patient’s burden of treatment because they’re not there in that patient’s day-to-day life.
Some of you know how cringe-worthy I consider the commonly used term “non-compliant“ to describe patients who don’t follow doctor’s orders.
Again and again during my four years of training, I encountered racism and ignorance, directed either at patients or at me and other students of color.
On my first day, I overheard the attending physician grumbling about accommodating an elderly Haitian man with limited English who had misunderstood his appointment time. “We’ll stick the med student on him,” he said.
I’ve been thinking about this because on Facebook recently I wondered aloud whether universities stigmatize conservatives and undermine intellectual diversity. The scornful reaction from my fellow liberals proved the point.
"Universities are unlike other institutions in that they absolutely require that people challenge each other so that the truth can emerge from limited, biased, flawed individuals,” he says. “If they lose intellectual diversity, or if they develop norms of ‘safety’ that trump challenge, they die.
It is here that the Dunning-Kruger effect comes to the fore, wherein antivaccine activists think that they understand as much or more than actual scientists because of their education and self-taught Google University courses on vaccines, that their pronouncements on vaccines should be taken seriously.
Doctors had told Jill’s father years earlier that his irregular heart rhythms had been due to some kind of virus. “It’s not,” Jill told him. “We have Emery-Dreifuss.”
She saved her dad’s life
But the neurologist would have none of it. “No, you don’t have that,” Jill recalls the neurologist saying sternly. And then she refused even to look at the papers.
Jill had been right about her self-diagnosis
she showed photos to doctors and told them she thought she had partial lipodystrophy. Just like before, they assured her it wasn’t the case.
she and Priscilla both have lipodystrophy
Two doctors had now shrugged their shoulders at my daughter’s symptoms. One wrote it off as a garden-variety headache, without ever asking if Darrah was on any medication. The other had dismissed our fears, then prescribed another drug known to cause the very same disorder. And through it all, our daughter’s symptoms continued to worsen.
Yet who was I to diagnose a rare disorder—on the Internet, no less? These two physicians had 30 years of clinical experience between them.
Sandmaier took Darrah to a top neuro-ophthalmologist at the University of Pennsylvania, saying nothing about her suspicions.
Your daughter is experiencing a rare side effect called pseudotumor cerebri
For e-patients like Marian Sandmaier, the traditional role of unknowing, uncomplaining, passive patient has gone the way of the horse and buggy.
As time was to tell, Adam was right, the medics were wrong. Adam's post mortem showed he died from very severe infection of the pancreas and very severe sepsis.
I can list several occasions in the last months of Adam's life where the clinician seemingly did not know more about medicine than a parent
At the risk of offending the whole medical profession, there will be occasions, when a child or parent may know something medical which a clinician, will not. Recognising that this can be the case is important.
By 2014, Alf was down to 80 pounds, with a grim prognosis.
Scouring the internet, Alf and her husband discovered something so new even her own doctors hadn’t heard about it. University of Pennsylvania researchers were organizing clinical trials to reprogram the immune systems of seriously ill myeloma patients like her.
Psychological safety is ‘‘a sense of confidence that the team will not embarrass, reject or punish someone for speaking up,’’ Edmondson wrote in a study published in 1999. ‘‘It describes a team climate characterized by interpersonal trust and mutual respect in which people are comfortable being themselves.’’
"Cultural humility is different than cultural competence..." @PCORnetwork #BuildingTrust
Tweeted by @mellojonny
"Premature closure? Not so fast"
[url]http://qualitysafety.bmj.com/content/early/2016/03/15/bmjqs-2016-005267.full[/url]Quotelearning about our flawed cognition keeps us humble.QuoteEven Kahneman, Nobel laureate and the founder of the heuristics and biases field, says at the end of his 400-page book Thinking Fast and Slow that after 30 years of study, he is no better at avoiding these biases than he was when he started. He says he may now recognise a few situations where he is at risk of making cognitive errors, but like all of us, he is still better at seeing them in other people than in himself.
In fact, physician training emphasizes the exact juxtaposition of this mindset, in that doctors are expected to be Always Right at least with their patients, and they are expected to cultivate a culture of deference and reserve between themselves and patients.
That's NOT how science works.
I think one of the reasons why we have this issue in medicine is: To become a doctor you go through this weeding-out process where you go to your chemistry classes and biology classes and take the MCATs. All of those, for the most part, are situations in which the person who gets the most right answers is rewarded. By the time you get to med school, you’re already primed to think that everything is about a right answer.
That’s where doctors find themselves in trouble. They don't even realize that, for instance, guidelines and recommendations are actually the synthesis of a lot of studies that are kind of fuzzy.
Frankly, physicians should NEVER feel threatened by questions or by second opinions. NEVER.
The students pondered this for a moment. Then one asked, tentatively, whether the reason we have so many patients like this in the U.S. — the kind that ask a lot of questions — might be our focus on “patient-centeredness.” Could we be giving our patients too much room to speak? At some point, he wondered, shouldn’t our knowledge, expertise and experience trump those endless questions?
I almost fell off my seat.
The wounded self may be the part of us incapable of forgetting, and perhaps, not actually meant to forget, as if, like the foundational dynamics of the physiological immune system our psychological defenses must remember and organize against any future attacks — after all, the identity of the one who must forgive is actually founded on the very fact of having been wounded.
Trust, by contrast, involves opening oneself to the possibility of betrayal, hence to a very deep form of harm. It means relaxing the self-protective strategies with which we usually go through life, attaching great importance to actions by the other over which one has little control.
It is hardly any surprise that elements of deep play can be found in most of our major efforts to make sense of the human experience, from Ancient Greek philosophy to Freud’s notion of “oceanic feeling” to Mihalyi Csikszentmihalyi’s concept of “flow.”
A century after Nietzsche, Hannah Arendt wrote beautifully about outsiderdom as a power and a privilege and James Baldwin asserted that it is the artist’s task to be the outsider disrupting society’s complacent stability.
Of one thing I am certain: a good teacher can only have dissident pupils
I realised that patients can see things in research that clinicians can’t because we think to look in new places, and we spot discrepancies that doctors take for granted.
Those who start off as academics also have to make the uncomfortable move from identifying as “Dr X, the ordinary researcher” to “Dr X, who is going to use his life experience (even his vulnerabilities) to make this research more relevant and effective.”
Today it’s hard to find a healthcare professional who doesn’t want to “put the patient first,” practise “patient centered care,” or make the patient “part” or even “the centre” of the healthcare team.
When, however, the conversation moves from the abstract patient to the real life patient whom clinicians meet in their daily practice, it’s amazing how quickly we, as patients, can slip off our sacred perch and be categorized as “difficult.”
I worry that using the term “difficult” establishes a framing effect—a cognitive bias—that may result in poor communication and tense patient-clinician relationships
We’re so afraid of disease, a single story can overwhelm our rationality. But that’s not the only reason people think all screening tests are always worthwhile. There are data traps here, too. Read more about lead-time bias and more
Rating a defendant’s risk of future crime is often done in conjunction with an evaluation of a defendant’s rehabilitation needs. The Justice Department’s National Institute of Corrections now encourages the use of such combined assessments at every stage of the criminal justice process. And a landmark sentencing reform bill currently pending in Congress would mandate the use of such assessments in federal prisons.
“Risk assessments should be impermissible unless both parties get to see all the data that go into them,” said Christopher Slobogin, director of the criminal justice program at Vanderbilt Law School. “It should be an open, full-court adversarial proceeding.”
Our goal in this paper is to tackle this tension head on. On the one hand, we want to describe and celebrate the therapeutic relationship in all its richness and mystery, rather than boil it down to a catchy mnemonic. On the other, Delamothe’s comment suggests that the extent to which the essence of this relationship eludes measurement is also the extent to which critics will denigrate it and policymakers will ignore it. Like all paradoxes, this one has no simple or correct solution – and readers should bear this in mind when they search either here or elsewhere for ‘evidence’ on the quality of the therapeutic relationship.
This systematic bias in survey instruments has remained.
We know that empathy and support from a doctor with whom one has a trusting, ongoing relationship is important to patients. We also know that healthcare organisations don’t or can’t prioritise it.
One member of my family who has a debilitating chronic disease is on appropriate treatment, but lacks a “therapeutic relationship” with a health professional. I have suggested that he goes to an online patient community for support.
White found that just 5% of the genetic variants previously linked to asthma in white kids played a similar role for black children.
“There’s a consistent underfunding of minority scientists,” Oh told BuzzFeed News.
funding bias
This legislation is part of a wave of religious-freedom bills that have been introduced and passed in the past year or so, almost all inspired by objections to homosexuality and same-sex marriage.
Medical exemptions, though, deserve to be considered in a category of their own. Doctors and therapists interact with people at their most vulnerable, and their training and expertise gives them incredible power over patients. The advice they provide—or refuse to provide—to an LGBT patient could influence the treatment that person seeks. It could make that person less likely to seek primary care or identify themselves as LGBT to other doctors, which can lead to the “failure to screen, diagnose, or treat important medical problems,” according to the American Medical Association.
“Blacks’ skin is thicker than whites’” and “Blacks’ nerve endings are less sensitive” were among the beliefs documented in the study of 222 white medical students, published earlier this month in the Proceedings of the National Academy of Sciences.
Unfortunately, telling people they have implicitly racist beliefs doesn’t seem to help correct the problem, either, Daniel Goldberg, a bioethicist at East Carolina University, told BuzzFeed News. “People just pat themselves on the back that now they are enlightened and go on acting the same way.”
The language gap frustrates your visit to your doctor.
there is some evidence that people who can speak more fluently receive better medical care; patients deprived of language are often subject to abuse
In the last decade or two, a new generation of doctor writers – including Atul Gawande, Abraham Verghese, Henry Marsh, Danielle Ofri, Siddhartha Mukherjee, Paul Kalanithi and Gavin Francis – have undertaken the mission of seeing in this fashion. For them, the ability to string together twin narratives, that of the doctor and that of the patient, is the only path to truth.
Why wasn’t this research published decades ago? It’s possible that modern computer technology allows us to do analyses that couldn’t be performed then. It’s possible that researchers tried, but were unable to get the results published.
But it’s also possible that these results were marginalized because they didn’t fit with what was considered to be “truth” at the time.
The aim of this study is to review highly cited articles that focus on non-publication of studies, and to develop a consistent and comprehensive approach to defining (non-) dissemination of research findings.
Our comprehensive framework of (non-) dissemination of research findings, based on the results of a scoping literature search and expert consensus will facilitate the development of future policies and guidelines regarding the multifaceted issue of selective publication, historically referred to as ‘publication bias’.
I had a rant to journalists about falling for the prestige bias/PR of high impact journals: Thx @tarahaelle @AHCJ
differences in goals, values and needs in the spheres of research and journalism
Impact factor journals are one of the key influences diverting journalists’ attention away from important research because of the advantage of prestige and resources. That’s not in the public interest.
California neurologist Faisal Qazi, 41, started a national campaign to raise money for the victims and families of the San Bernardino massacre after he discovered some were his neighbors. A colleague heard about the fund and became very angry, Qazi said. The surgeon, face flushed, confronted Qazi and told him Trump was right, that '"we should get rid of all the Muslims."
The most common reason that doctors said they stereotyped patients was because of their emotional problems, which elicited biases among 62% of physicians, followed by their weight, which 56% of male and 48% of female physicians said provoked biases for them. Other triggers were patients' intelligence, language differences, insurance coverage, age, income level, race and attractiveness.
The preponderance of evidence suggests that doctors do give different care to different groups of patients.
Researchers analyzed audio and video recordings of the encounters, which included coding verbal emotion-handling and shared decision-making behaviors, as well as non-verbal behaviors including time spent with a patient and/or surrogate; open versus closed posture; touching the patient; and physical proximity.
However, at least one thing is certain: body language is essential in building trust, whether at home, work, school — or even a doctor’s office.
Accordingly, the workshop sought to focus on philosophical and psychological aspects of the research-practice gap. How humans behave is underpinned by how they think. Thinking styles are in turn influenced by underlying cognitive mechanisms (including biases), intellectual virtues (e.g. conscientiousness, open-mindedness) and intellectual vices(dogmatism, closed-mindedness, prejudice). Clinical practice is also strongly influenced by professional virtues (e.g. altruism, integrity, respect for confidentiality), and, regrettably, also sometimes by what might be termed professional vices (e.g. tendency to close ranks, unwillingness to own up to mistakes).
Not only does empathy seem to fail when it is needed most, but it also appears to play favorites. Recent studies have shown that our empathy is dampened or constrained when it comes to people of different races, nationalities or creeds. These results suggest that empathy is a limited resource, like a fossil fuel, which we cannot extend indefinitely or to everyone.
In science as in politics, most people agree that transparency is essential. Top journals now require authors to disclose their funding sources so that readers can judge the possibility of bias, and the British Medical Journal recently required authors to disclose their data as well so that experts can run independent analyses of the results. But as transparency becomes the standard, many academics are resisting the trend without pushback from their universities.
Important essay on explaining risk to patients science.sciencemag.org/content/352/62…
@sciencemagazine #dataviz #PWSYN @BeckmanInst
Contemporary research on medical decision-making originates from two traditions in the psychological sciences.
The "heuristics and biases" view
The "ecological rationality" view
Tweeted by @PaulflevyQuote1/2 It’s often said that we learn from our mistakes. But often not so true! athenahealth.com/leadership-for….
"Do we really learn from our mistakes?"
[url]http://www.athenahealth.com/leadership-forum/really-learn-mistakes[/url]QuoteWe teach doctors about these cognitive weaknesses — anchoring, confirmation bias, and patterning — but we tell them that they are unlikely to recognize that they are happening. Instead, we need them to buy into systems of group behavior that protect them from themselves.
Some readers told me to “grow a thicker skin” or “stop looking for racism in every corner.” One tweeted: “People are not responsible for creating a safe space around you.”
That means we have to learn to communicate better: We have to find ways to stand up for our colleagues when they’re insulted by patients — or by others on staff.
Many minorities in medicine, from undergraduates to seasoned professionals, try to avoid being labeled as a “troublemaker” by putting up with intolerance, putting their heads down, and “pushing through.”
"Ever since I learned about confirmation bias I've started seeing it everywhere." - @jonronson
.@thackerpd @garyschwitzer I'm equally concerned about less obvious points: non-financial COIs - grants, fellowships, friendship, other ties
RW: You’re worried that Cochrane Collaboration reviews — the apex of evidence-based medicine — “may cause harm by giving credibility to biased studies of vested interests through otherwise respected systematic reviews.” Why, and what’s the alternative?
Even scientists sometimes don’t take the importance of being wrong seriously enough. This is due in no small part to the confirmation bias that seems built into our humanity. We are more likely to seek out and place value in information that confirms our own existing beliefs.
Luke: Is the dark side stronger?
Yoda: No - quicker, easier, more seductive... like a giving a TED talk.
not including proper controls, omitting data that doesn’t fit expectations, letting assumptions go untested
The Master said: “Do not be concerned that you have no position, be concerned that you have what it takes to merit a position. Do not be concerned that no one recognises you, seek that which is worthy of recognition.” For all his considerable merits, Confucius, whose words these are, would have made a rotten academic mentor at today’s university.
Nowadays, it is all about show.
That happens because the TRUTH is most important.
Science is all about second, third, fourth, and fifth opinions. Evidence-based medicine needs to be, too, if it seeks better truth with greater efficiency. That's where I think that most medical practice still errs. It hopes for fewer human beings to be involved in the interests of "efficiency."
Hubris, that. Science is the most efficient truth-seeking mechanism that human beings have ever devised. And it REQUIRES multiple participants, because each of them comes at a problem with different biases, previous experience, etc. You can't skip that step and have it work.
Patient, doctor, academic, this lecture is worth your time. #meded #FOAMed
JPA Ioannidis on EBM being hijacked by $$ COI; Harms of Financial COI; False promises; Funding; A MUST WATCH!
Struggle toward the capital-T Truth, but recognize that the task is impossible - or that if a correct answer is possible, verification certainly is impossible.
In the end, it cannot be doubted that each of us can see only a part of the picture. The doctor sees one, the patient another, the engineer a third, the economist a fourth, the pearl diver a fifth, the alcoholic a sixth, the cable guy a seventh, the sheep farmer an eighth, the Indian beggar a ninth, the pastor a tenth. Human knowledge is never contained in one person. It grows from the relationships we create between each other and the world, and still it is never complete. And Truth comes somewhere above all of them
I'm totally happy for us to make your medical plan together
But if you ever want me to just be the doctor, I'm happy to do that, too.
I hadn't ever considered that I could release myself from the responsibility of my own medical care. I'd just assumed all patients became experts at their own diseases.