Why Doctors Hate Science

[RationalVetMed]

"Civil Engineer Ivor, I need a bridge across this ravine."
"Okay, here are the 2 ways we can build it."
"I don't like it. I want it built up side down with laser beams."
"Uh...okay, I could do it this way."
"No, I want it with laser beams and Swiss cheese."
"But the bridge will collapse."
"Why are you so paternalistic? Why don't you respect my autonomy?"

Brilliant etc...

Yuri

 

[paximperium]

Hmmm...not to derail, but do you actually attend pharmaceutical company sponsored events?

Rarely and it isn't easy to avoid either. My ER group's meetings occasionally gets sponsored so I sit through their spiel, have lunch and continue on with the meeting. There's no way to avoid those.

As for one of the large pharma sponsored events in some nice locales, I don't go to those. I do go to paid medical education events in nice places and sometimes there are pharma sponsors but they usually just keep to their booths and have some banners around.

I personally don't like taking stuff from them. I don't even take pens from them. I can buy a pack of 10 good quality pens from Costco. I don't need to beg for freebies and any medical work related spending is tax deductible.

 

[paximperium]

lol...of course. They are one of many ways of providing me with continued medical education. I do not attend many, as 90% of my CME is through the Canadian College "Self Learning" modules and online CME, but I do go occasionally.

Why do you ask?

TAM

I get about 50% free from various hospital programs and I pay for about 20% of them. The rest is free on the Internet...gotta love the Internet.

 

[paximperium]

This description is simply too far removed from reality to address.

The leading and loaded questions were a dead give away.

 

[Ivor the Engineer]

The leading and loaded questions were a dead give away.

Nah, Linda always clams up when I ask her tough questions and instead just looks down her nose at me (metaphorically speaking). I've gotten so used to it I wouldn't know what to do if she did something else.

 

[Piscivore]

In most cases, however, patients clients come in with all sorts of incorrect conclusions about what they have. Not all of them are convinced they are wrong. Then you get resentment (again not so rare).

I get exactly the same thing in the auto insurance industry.

 

[T.A.M.]

I get about 50% free from various hospital programs and I pay for about 20% of them. The rest is free on the Internet...gotta love the Internet.

yah when I was working in the ER we needed regularly updated ATLS and ACLS, so you got 25 credits for each, and only need 125 M1 Credits in a 5 year cycle, so it took the burden off.

Working in a rural ER, I was able to get the health care board to pay for mine.

TAM

 

[Ivor the Engineer]

http://en.wikipedia.org/wiki/Medical_Ethics#Beneficence

The article that KellyB referenced earlier also covered the same points about the conflict between beneficence and autonomy.

From the wiki page:

In the medical context, this means taking actions that serve the best interests of patients. However, uncertainty surrounds the precise definition of which practices do in fact help patients.

So beneficence in this context is second-guessing what the patient wants.

I'm pretty sure you decided to make me look foolish in another thread for suggesting a similar strategy when no other source of information was available.

My feelings. I am, of course, completely devoid of insight.

I wouldn't say that. You're just doing your bit for the 'JREF medical professionals unified front'.

This description is simply too far removed from reality to address.

Linda

You are of course free to avoid answering any questions you don't want to.

 

[paximperium]

I wouldn't say that. You're just doing your bit for the 'JREF medical professionals unified front'.

Sieg Heil to the JREFMPUF!!!

 

[Ivor the Engineer]

I like to think I'm a healthy option for woo pack hunters who fancy a bit of variety.

 

[Aerik]

OK, after 11 pages, did anybody else notice that the author of this article erroneously assumes that every hysterectomy removes the cervix? Literally seconds of real research reveals that often there is a part of the cervix left behind, called the supracervical. And you do still need pap smears on that, as it does get HPV, and hence does get cancer.

 

[fls]

From the wiki page:

So beneficence in this context is second-guessing what the patient wants.

Not at all.

I'm pretty sure you decided to make me look foolish in another thread for suggesting a similar strategy when no other source of information was available.

No, that was merely a side effect. It's really the Golden Rule that's foolish.

I wouldn't say that. You're just doing your bit for the 'JREF medical professionals unified front'.

It's JUMP - I think it was choosen to reflect how amenable physicians are to jumping through hoops,*although I missed a few of the meetings near the end.

You are of course free to avoid answering any questions you don't want to.

Pure altruism on my part. You may be familiar with the study where warnings about false claims were remembered as recommendations?

https://pal.utdallas.edu/pubs/publication/download/148

The problem is that "when did you stop beating your wife" questions require extra-sooper-dooper discussion in order to unpack all the assumptions before addressing the statement. All that reinforcement means that you remember the statement "medical students are not taught an interactive model", but after a bit, you no longer remember whether it is true or false. I wouldn't want you to fall for the "if I remember it, it's probably true" trap and blithely use the statement as though it were true. It might be embarrassing if you find yourself in a conversation with people who know that it's false. I wouldn't want that to happen to you.

Linda

*laughing madly at my joke

 

[T.A.M.]

OK, after 11 pages, did anybody else notice that the author of this article erroneously assumes that every hysterectomy removes the cervix? Literally seconds of real research reveals that often there is a part of the cervix left behind, called the supracervical. And you do still need pap smears on that, as it does get HPV, and hence does get cancer.

yes I believe I mentioned that very early in the thread (or was it in another thread). The older the patient, the more likely this is the case, in general.

TAM

Edit: yes post #18 in this thread.

TAM

 

[Skeptic Ginger]

...

What appears to be the difference of opinion is whether or not patients, in general, have the competence to be able to make an informed choice about accepting or rejecting treatment proposed by a physician.

From my perspective, the difference of opinion is in your not recognizing a physician/nurse practitioner usually takes into account the competence of the patient. You have such a narrow black and white view of the patient provider interaction. That's why I say you may be going into a provider's office already convinced of the outcome.

 

[Skeptic Ginger]

Hmmm...not to derail, but do you actually attend pharmaceutical company sponsored events?

Yeah, they usually have the best free food to go with the free CME credits one needs to remain licensed.

I too, however, now get most my CE free online. It's just not worth the time it takes for free dinners and lunches when you have an online option.

 

[BillyJoe]

Thanks for your responses. It's nice to see a healthy scepticism of the pharmaceutical companies and an awareness of their potential to influence your prescribing behaviour.

 

[Ivor the Engineer]

Not at all.

How do you determine what is in the best interests of a patient?

No, that was merely a side effect. It's really the Golden Rule that's foolish.

IIRC, I didn’t suggest starting with the Golden Rule, but falling back on it when other sources of information are unavailable. But you saw a chance to assert your superiority and just couldn’t resist.

<snip>

Pure altruism on my part. You may be familiar with the study where warnings about false claims were remembered as recommendations?

https://pal.utdallas.edu/pubs/publication/download/148

The problem is that "when did you stop beating your wife" questions require extra-sooper-dooper discussion in order to unpack all the assumptions before addressing the statement. All that reinforcement means that you remember the statement "medical students are not taught an interactive model", but after a bit, you no longer remember whether it is true or false. I wouldn't want you to fall for the "if I remember it, it's probably true" trap and blithely use the statement as though it were true. It might be embarrassing if you find yourself in a conversation with people who know that it's false. I wouldn't want that to happen to you.

Linda

You might want to check the questions I asked, rather than the questions you thought I asked. Here they are again, split up so we can see which questions are of the form “when did you stop beating your wife?”:

Has the alternative [to the physician hiding her reasoning processes from the patient] even been tried?

Assumes you and the other physicians are being honest when reporting how you practice. Otherwise a perfectly straightforward question.

Do medical students fail if they don't follow a particular model of interacting with patients?

No assumptions in this question. Ironic this was the one you misremembered as being loaded.

Are the problems caused because the public expects doctors to treat them in a certain way - if doctors switched to the interactive model would patients get used to it after a while?

This was in reference to your point about not telling a patient cancer is one of the possible causes of their symptoms until it is ruled-in. As with the first question, it assumes that you and the other physicians haven’t been telling me a pack of lies about how you deal with patients.

Would patients then be distressed if a doctor decided to not share information with them about how she was thinking?

Again, this assumes (based on information provided by you and other physicians) that physicians generally don’t expose their reasoning processes to the patient, but behave instead as medical ‘black boxes’.

i.e., is this just resistance to change in spite of likely benefits for patients (and probably doctors too)?

The assumptions in this question are that physicians generally still practice in a ‘black box’ way, and having patients take an active role in both their diagnosis and treatment would result in benefits for both parties.

Here are the same questions presented in an unloaded way:

1. Has there been any studies performed on what type of doctor-patient relationship produce the best outcomes? If so, did any of them have the doctor being open about her reasoning with the patient?

2. Do medical students fail if they don’t follow a particular model of interacting with patients?

3. In general are physicians open about their reasoning processes with their patients? If not, is this because they believe (rightly or wrongly) that their patients expect them to behave in a certain way?

4. If patients are used to physicians behaving in a particular way, would they be distressed if physicians changed how they behaved? Would this distress be permanent, or would patients get used to the different way of behaving and begin to prefer and expect it after a while?

5. Do physicians resist being moved from their zone of comfort as much as everyone else does?

 

[T.A.M.]

Here are the same questions presented in an unloaded way:

1. Has there been any studies performed on what type of doctor-patient relationship produce the best outcomes? If so, did any of them have the doctor being open about her reasoning with the patient?

2. Do medical students fail if they don’t follow a particular model of interacting with patients?

3. In general are physicians open about their reasoning processes with their patients? If not, is this because they believe (rightly or wrongly) that their patients expect them to behave in a certain way?

4. If patients are used to physicians behaving in a particular way, would they be distressed if physicians changed how they behaved? Would this distress be permanent, or would patients get used to the different way of behaving and begin to prefer and expect it after a while?

5. Do physicians resist being moved from their zone of comfort as much as everyone else does?

1. I do not recall a particular study off the top of my head, but I do remember someone mentioning that patients considered "listening" and "bedside manner" as two things that influenced their opinion of their MDs.

2. In Canada we have OSCE (Objective Structured Clinical Exam) which tests clinical skills, and at the CFPC (College of Family Physicians of Canada) level, we have the SOO (Simulated Office Orals) which is totally about clinical skill, bedside manner, open ended questioning, etc... If you do not pass them, you do not receive certification.

3. How open or not, I am with a patient about my reasoning depends on the patient, and my sense of whether or not they want to know, etc...

4. Given how long medicine has been practiced the way it has, I suspect it would take a long time for patients to adapt, but who knows.

5. Of course we do not like being moved from our comfort zone. That does not mean that we do not, or cannot.

TAM

 

[paximperium]

Here are the same questions presented in an unloaded way:

Much better. And now you'll get your answers.

1. Has there been any studies performed on what type of doctor-patient relationship produce the best outcomes? If so, did any of them have the doctor being open about her reasoning with the patient?

Not that I'm aware of. Even dress does not significantly change patient's perception. The problem with such a study is the difficulty for controlling such a multitude of differing factors.

2. Do medical students fail if they don’t follow a particular model of interacting with patients?

Not really. In the US, we have History and Physical components that med students must meet but it has more to do with assessing skills in actually collecting information as opposed to interactions. They get advise by the preceptor as to the best way to collect info and to interact with patients. We have a more formal USMLE Step 2-CS component which has more to do with assessing basic clinical skills as opposed to interaction skills.

3. In general are physicians open about their reasoning processes with their patients? If not, is this because they believe (rightly or wrongly) that their patients expect them to behave in a certain way?

I am and many who I work with are as well. If I don't know what's causing their chest pain, I tell them I have no idea but I've worked up their heart and lungs to make sure the big scary stuff isn't the cause.

Some patients on the other hand don't care and just want to be told what to do.

4. If patients are used to physicians behaving in a particular way, would they be distressed if physicians changed how they behaved? Would this distress be permanent, or would patients get used to the different way of behaving and begin to prefer and expect it after a while?

It depends. Some patients expect a very formal and paternalistic doctor and some expect someone who listens more and get them involved with their care. It's too variable to generalize.

5. Do physicians resist being moved from their zone of comfort as much as everyone else does?

I actually enjoy it but then I get moved out of my comfort zone all the time. Comes with working in the ER. Me like the adrenaline.

 

[fls]

How do you determine what is in the best interests of a patient?

Evidence-based medicine plus consideration of the individual.

IIRC, I didn’t suggest starting with the Golden Rule, but falling back on it when other sources of information are unavailable. But you saw a chance to assert your superiority and just couldn’t resist.

Why would you assume my opinion is superior to yours? I doubt that you actually believe that.

You might want to check the questions I asked, rather than the questions you thought I asked. Here they are again, split up so we can see which questions are of the form “when did you stop beating your wife?”:

Assumes you and the other physicians are being honest when reporting how you practice. Otherwise a perfectly straightforward question.

It assumes that you have accurately characterized what has been said.

No assumptions in this question. Ironic this was the one you misremembered as being loaded.

That was not the question I was referring to as loaded.

This was in reference to your point about not telling a patient cancer is one of the possible causes of their symptoms until it is ruled-in. As with the first question, it assumes that you and the other physicians haven’t been telling me a pack of lies about how you deal with patients.

It assumes that you have accurately characterized what was said. It also contains the question that contained hidden assumptions

Again, this assumes (based on information provided by you and other physicians) that physicians generally don’t expose their reasoning processes to the patient, but behave instead as medical ‘black boxes’.

It assumes that you have accurately characterized what was said.

The assumptions in this question are that physicians generally still practice in a ‘black box’ way, and having patients take an active role in both their diagnosis and treatment would result in benefits for both parties.

Here are the same questions presented in an unloaded way:

1. Has there been any studies performed on what type of doctor-patient relationship produce the best outcomes? If so, did any of them have the doctor being open about her reasoning with the patient?

Yes.

Yes.

2. Do medical students fail if they don’t follow a particular model of interacting with patients?

No, although that depends upon how vaguely you define "particular model".

3. In general are physicians open about their reasoning processes with their patients? If not, is this because they believe (rightly or wrongly) that their patients expect them to behave in a certain way?

I think generally they are and then circumstances influence whether it is possible or appropriate.

I don't think that physicians generally ignore patient expectations.

4. If patients are used to physicians behaving in a particular way, would they be distressed if physicians changed how they behaved? Would this distress be permanent, or would patients get used to the different way of behaving and begin to prefer and expect it after a while?

I don't think so. Satisfaction is somewhat tied to expectation, but it mostly seems to be tied to patient-centered factors - discussing psychosocial concerns instead of biomedical concerns, patients doing the talking, etc.

5. Do physicians resist being moved from their zone of comfort as much as everyone else does?

I suppose. Although, we have more experience with being forced out of our zone of comfort than average, which may lead to less resistance than average due to familiarity.

Linda