Bias

[LinksEtc]

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. 

When Doctors Should Say 'I Don't Know'
http://www.theatlantic.com/health/archive/2016/02/when-doctors-should-say-i-dont-know/471222/?utm_source=SFTwitter

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.

[LinksEtc]

Frankly, physicians should NEVER feel threatened by questions or by second opinions.  NEVER. 

Tweeted by @ESchattner

Narrating Medicine: The Patient Who Peppers You With Questions Is Not Being 'Difficult'
http://commonhealth.wbur.org/2016/03/patient-questions

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.

I've learned to be careful with what I ask & how I ask .... truly, once you've learned the lesson of what can happen if you annoy/anger a doc ... well, I can't unlearn that ... it now seems to be a part of me at a very basic, almost instinctual level.


---------------------------------------------------------



"Poet and Philosopher David Whyte on Anger, Forgiveness, and What Maturity Really Means"
https://www.brainpickings.org/2015/05/15/david-whyte-consolations-anger-forgiveness-maturity/

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.

---


"Philosopher Martha Nussbaum on Anger, Forgiveness, the Emotional Machinery of Trust, and the Only Fruitful Response to Betrayal in Intimate Relationships"
https://www.brainpickings.org/2016/05/03/martha-nussbaum-anger-and-forgiveness/

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.

---


"Diane Ackerman on the Evolutionary and Existential Purpose of Deep Play"
https://www.brainpickings.org/2016/08/04/diane-ackerman-deep-play/

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."

---


"Pioneering Scientist Erwin Chargaff on the Power of Being an Outsider and What Makes a Great Teacher"
https://www.brainpickings.org/2016/07/27/erwin-chargaff-heraclitean-fire-misfit/

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

[CMdeux]

I now just drag it out into the open with physicians.

I actually made a wisecrack about not being a Munchausen mom-- honest-- when DD16 was in urgent care for the second time in a week for her asthma.

I could see that he was wondering about my background when I was more at east with the pharmacology and mechanisms at work than he was....

his answer surprised me some, though-- he laughed (genuinely) and said "Nope-- never thought that for a minute!  Those are generally pretty obvious, because they don't use the terms the way medically-trained people do.  There's always something just a bit-- off-- about their thinking.  I can always tell when someone is a researcher or doctor themselves."


But yes, I've spent some tense moments with doctors where I wondered what they were thinking about ME.  I've encountered those that think I know more than I should-- and I'm less trusting of their judgment than they are comfortable with.

[LinksEtc]

.

[LinksEtc]

"Rosamund Snow: What makes a real patient?"
http://blogs.bmj.com/bmj/2016/07/19/rosamund-snow-what-makes-a-real-patient/

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."

------------------


"Suzanne Gordon on the difficult patient"
http://blogs.bmj.com/bmj/2016/03/22/suzanne-gordon-on-the-difficult-patient/

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

-----------------


"Screening: powered by anecdotes"
http://sci-med-cartoonery.tumblr.com/post/143995401293/screening-powered-by-anecdotes

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

-----------------------



Tweeted by @ckeet

"Machine Bias"
There's software used across the country to predict future criminals. And it's biased against blacks.
by Julia Angwin, Jeff Larson, Surya Mattu and Lauren Kirchner, ProPublica
https://www.propublica.org/article/machine-bias-risk-assessments-in-criminal-sentencing?utm_campaign=sprout&utm_medium=social&utm_source=twitter&utm_content=1464005722

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."

[LinksEtc]

"Measuring quality in the therapeutic relationship"
Trisha Greenhalgh
Iona Heath
http://www.kingsfund.org.uk/sites/files/kf/field/field_document/quality-therapeutic-relationship-gp-inquiry-discussion-paper-mar11.pdf

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.

----------------


"Tessa Richards: "Therapeutic relationships"—prized but hard to deliver"
http://blogs.bmj.com/bmj/2016/08/01/tessa-richards-a-therapeutic-relationship-is-worth-rubies/

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.

---------------


"Meet The Scientists Fighting For More Studies On Genes And Racial Differences In Health"
https://www.buzzfeed.com/peteraldhous/science-so-white?utm_term=.jtRkMkVL2e#.arM1w1pKNe

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

[LinksEtc]

"When Doctors Refuse to Treat LGBT Patients"
A new law in Mississippi makes it legal for physicians and therapists to opt out of care on religious grounds. What does this mean for medicine?

http://www.theatlantic.com/health/archive/2016/04/medical-religious-exemptions-doctors-therapists-mississippi-tennessee/478797/

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.

------------------


"Many Doctors Hold Racist Beliefs About How Black People Feel Pain"
https://www.buzzfeed.com/danvergano/race-pains

"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."

------------------


'Literature about medicine may be all that can save us'
http://www.theguardian.com/books/2016/apr/22/literature-about-medicine-may-be-all-that-can-save-us?utm_content=bufferea2f5&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

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.

[LinksEtc]

"A Study on Fats That Doesn't Fit the Story Line"
http://www.nytimes.com/2016/04/16/upshot/a-study-on-fats-that-doesnt-fit-the-story-line.html?smid=tw-share&_r=2

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.

----------------------



Bias in dissemination of clinical research findings: structured OPEN framework of what, who and why, based on literature review and expert consensus
http://bmjopen.bmj.com/content/6/1/e010024.full.pdf

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'.

----------------------



Tweeted by @hildabast

I had a rant to journalists about falling for the prestige bias/PR of high impact journals: Thx @tarahaelle @AHCJ

"How to think about impact factors: A researcher's perspective"
http://healthjournalism.org/blog/2016/08/how-to-think-about-impact-factors-a-researchers-perspective/?utm_source=twitterfeed&utm_medium=twitter

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.

[LinksEtc]

American Muslim doctors feel greater scrutiny, even patients' suspicions
https://www.washingtonpost.com/news/to-your-health/wp/2015/12/11/american-muslim-doctors-feel-greater-scrutiny-even-patients-suspicions/

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 doctor will judge you now"
http://www.cnn.com/2016/01/19/health/doctor-patient-bias-survey/index.html

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.

---------------


"Race In Health Care: Doctors' Distinct Body Language May Reveal Racial Bias Toward Patients"
http://www.medicaldaily.com/race-health-care-doctors-distinct-body-language-may-reveal-racial-bias-toward-367966

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. 

[LinksEtc]

"Virtues and vices in evidence based clinical practice"
Trish Greenhalgh
http://www.phc.ox.ac.uk/blog/virtues-and-vices-in-evidence-based-clinical-practice

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).

----------------------


"Empathy Is Actually a Choice"
http://www.nytimes.com/2015/07/12/opinion/sunday/empathy-is-actually-a-choice.html?_r=0

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.

[LinksEtc]

Op-Ed
"In science, follow the money – if you can"
http://www.latimes.com/opinion/op-ed/la-oe-0512-thacker-furberg-transparency-science-20160512-story.html

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.

------------------------------



Tweeted by @EricTopol

Important essay on explaining risk to patients science.sciencemag.org/content/352/62...
@sciencemagazine #dataviz #PWSYN @BeckmanInst

"Risk literacy in medical decision-making"
http://science.sciencemag.org/content/352/6284/413.summary

Contemporary research on medical decision-making originates from two traditions in the psychological sciences.

The "heuristics and biases" view

The "ecological rationality" view

--------------


Risk Literacy

[LinksEtc]

Re: Patient safety

Tweeted by @Paulflevy

1/2 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?"
http://www.athenahealth.com/leadership-forum/really-learn-mistakes

We 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.

--------------------


I told my story about racism in medical school. Here's what readers taught me.
https://www.statnews.com/2016/04/27/racism-medicine-lessons/

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."

--------------------



Tweeted by @AcademicsSay

"Ever since I learned about confirmation bias I've started seeing it everywhere." - @jonronson

--------------------



Tweeted by @ESchattner

.@thackerpd @garyschwitzer I'm equally concerned about less obvious points: non-financial COIs - grants, fellowships, friendship, other ties

[LinksEtc]

"Evidence-based medicine has been hijacked:" A confession from John Ioannidis
http://retractionwatch.com/2016/03/16/evidence-based-medicine-has-been-hijacked-a-confession-from-john-ioannidis/

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?

------------------------



Tweeted by @MU_Peter

"Why it's crucial that young scientists are taught the value of being wrong"
https://theconversation.com/why-its-crucial-that-young-scientists-are-taught-the-value-of-being-wrong-54839

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.

[LinksEtc]

I can't resist  ...



"ALL THE YOUNG JEDIS"
http://www.curiumco.com/news-master/2016/1/28/all-the-young-jedis

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

------------------------------------------



"Last Week Tonight with John Oliver: Scientific Studies (HBO)"
https://m.youtube.com/watch?v=0Rnq1NpHdmw&feature=share

------------------------------------------



Tweeted by @GoAllergy

"University research and the rise of academic bragging contests"
http://www.theguardian.com/education/2016/may/17/university-research-academic-bragging-grants?CMP=share_btn_tw

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.

------------------------------------------



"The Science News Cycle"


http://www.phdcomics.com/comics.php?f=1174

[LinksEtc]

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.

--------------


Thought you would like this CM ...


Tweeted by @drjohnm

Patient, doctor, academic, this lecture is worth your time. #meded #FOAMed

Tweeted by @VinayPrasad82

JPA Ioannidis on EBM being hijacked by $$ COI; Harms of Financial COI; False promises; Funding; A MUST WATCH!

---


Lown 2016 - Dr. John Ioannidis Keynote: Evidence-Based Medicine Has Been Hijacked
https://www.youtube.com/embed/N63skNtYaJw


-------------------------------------



a preprint ...


Is most published research really false?
Jeffrey T. Leek1,2,* and Leah R. Jager1
1Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health

http://biorxiv.org/content/biorxiv/early/2016/04/27/050575.full.pdf


-------------------------------------



"When Breath Becomes Air"
Paul Kalanithi

Page 172

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

Pages 182

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.