Bias

[LinksEtc]

Before I try leaving again, I can't resist starting this topic ...

[LinksEtc]

Tweeted by @mellojonny


"Premature closure? Not so fast"
http://qualitysafety.bmj.com/content/early/2016/03/15/bmjqs-2016-005267.full

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.

[LinksEtc]

Tweeted by @hildabast


http://statistically-funny.blogspot.com/2016/08/cupids-lesser-known-arrow.html

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".

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


Tweeted by @kevinmd


"Physicians must admit and recognize their biases"
http://www.kevinmd.com/blog/2016/03/physicians-must-admit-recognize-biases.html

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."

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


Tweeted by @ESchattner


"Speaking Truth to Power and the Value of Counterpoints: Madeleine Albright's Surprising Commencement Address"
https://www.brainpickings.org/2016/05/19/madeleine-albright-scripps-commencement-address/

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.

[LinksEtc]

"When Doctors Discriminate"
http://www.nytimes.com/2013/08/11/opinion/sunday/when-doctors-discriminate.html

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.

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



Tweeted by @ivanoransky


"Doctors are more likely to misdiagnose patients who are jerks"
http://www.vox.com/2016/3/19/11265464/doctors-misdiagnose-rude-patients

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.

[LinksEtc]

"When Patients Are a Pain for Their Doctors"
http://www.wsj.com/articles/when-patients-drive-their-doctors-crazy-1459793860

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.

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



"maintaining boundaries with patients"
http://www.cpso.on.ca/CPSO/media/images/Maintaining-Boundaries.pdf

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 are jaded, but this is what keeps them in medicine"
http://www.kevinmd.com/blog/2015/12/physicians-jaded-keeps-medicine.html?utm_content=buffer9f2c5&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

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.

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



Re: If you were an allergy researcher ...

There's something that is really quite perfect for this thread ... & in more than one way ...

"Biologist talks to statistician"
http://m.youtube.com/watch?v=Hz1fyhVOjr4

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. 

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



Re: Docs helping patients to surf the internet


"Doctors and the Google Threat"
http://33charts.com/2015/12/doctors-google-threat.html?utm_content=buffere2363&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

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.

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


"Dear Doctors: Please Do Not Confuse Your Medical Degree with my Google Search"
http://lisa.ericgoldman.org/general/dear-doctors-please-do-not-confuse-your-medical-degree-with-my-google-search

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.

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



A lot more on this topic in that thread ... for ex ...

Re: Docs helping patients to surf the internet

[LinksEtc]

The Skills We All Need to Move Past "Anti-Science" and "Us"
http://blogs.plos.org/absolutely-maybe/2016/03/31/the-skills-we-all-need-to-move-past-anti-science-and-us/

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.

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



"Sorry Medicine, I Don't Think More Empathy Is The Answer"
https://mssinenomineblog.wordpress.com/2016/03/23/sorry-medicine-i-dont-think-more-empathy-is-the-answer/

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.

----------


"The Art of Medicine: W.H. Auden on What Makes a Great Physician and How He Influenced Oliver Sacks"

https://www.brainpickings.org/2016/05/19/w-h-auden-commonplace-book-medicine/?mc_cid=94b2eea625&mc_eid=fb77afa158

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

[LinksEtc]

Saw this conversation/topic yesterday ... probably relevant to this thread so ....




Tweeted by @AllergyKidsDoc

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!

Tweeted by @harriet75

@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

---


"A warning against crowdsourcing your medical care on social media"
EMILY MCCULLAR, MD
http://www.kevinmd.com/blog/2016/04/a-warning-against-crowdsourcing-your-medical-care-on-social-media.html

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?

---------


ok, before I continue, let me just agree that during reactions, you have to get off social media and follow your "allergy action plan / emergency care plan" given to you by your doc ... use the epi & call 911 without delay if it is what the doc has advised for the reaction.

However, regarding the general crowdsourcing concept in a non-emergency situation ... this is where, I think, some docs have confirmation bias ... seeing mostly risks/dangers without considering the potential positives/benefits ... so since this is a bias thread, let me include this ...

---


Tweeted by @disruptivewomen

"This woman's rare disease was diagnosed by...Imgur?"
http://www.dailydot.com/lifestyle/imgur-rare-disease-diagnosed-woman/

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.

---


Let me link here also since it touches on that "trust" concept:
Re: Docs helping patients to surf the internet

---


I think docs should give patients handouts with lists of the doc-backed sites ... FARE, AAFA/KFA, etc. ... and they should warn patients about all the bad internet info ... the dangers of social media ...

at the same time, I think the docs have to accept that many patients are eventually going to venture into the wild world of the larger Internet for all sorts of things including medical concerns (patients are autonomous people) ...where there is both good & bad info, risks & benefits ... where it is not as safe ...

my gut says that docs are probably fighting a losing battle if their goal is to stop this trend ...

however, I think that docs on SM can have a huge positive impact posting good info online, calling out bs, communicating with and teaching/guiding patients to be smarter, more skilled, web surfers - turning the patients into allies who also will call out bs in their own social networks, who will tell other patients to get off the Internet and go to the ER, etc. ...

again, I think patients & docs should keep the lines of communication open about internet issues ...
anger, ridicule, fear of annoying, fear of offending, fear of negative judgement ... these, just from my own experience, I feel are barriers to that open communication that is necessary ...

patients have different levels of intelligence & experience & ability ... but the basic drives to learn & to understand & to connect with others & to be involved with their own medical care are pretty widespread ... some patients may not be able to appreciate their own limitations ... to see their own biases ... all of this definitely presents challenges to medical professionals ...

at this point, I feel that I have some grasp of the perspectives of both "sides" ...

my guess is that many docs don't really "get" the patient perspective ... I'd like to see patients given more of an opportunity to share their perspectives on health care social media ... often, their voices are underrepresented ...let them explain why & how they are using social media for medical stuff ... allow real conversations between patients & docs ... let the patients help develop strategies to address the dangers of the Internet ... give a chance for more unmet patient needs to be addressed, etc. ...

sorry, much rambling, here.

Anyway, people are free to disagree with me ... this is just my non-expert opinion at this time.

[LinksEtc]

Tweeted by @AllergyKidsDoc

This video illustrates a story I've heard from some #foodallergy families about disagreement in the ER

"ER: Child With Suspected Anaphylaxis"
Julie Brown
Published on Jun 23, 2016
"A child with a milk allergy presents with vomiting. The mother suspects it is an allergic reaction. The ER doctor disagrees. Who is the expert in this case?"

https://m.youtube.com/watch?v=rj7izbn_wSU&feature=youtu.be


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



I'm not going to go through & pick out individual posts, but bias was a topic in these threads ...


If you were an allergy researcher ...


Lala's DS-- passing a peanut challenge and REDEVELOPING the allergy


Tweet response for @GilmerHealthLaw


Let's talk about anxiety


Docs helping patients to surf the internet


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


"Implicit bias in health care"
http://www.jointcommission.org/assets/1/23/Quick_Safety_Issue_23_Apr_2016.pdf

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

[LinksEtc]

a bit off topic .. but important b/c about really listening ...

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


Tweeted by @EricTopol

"Here's Why We Struggle To Make Connections With Our Physicians — And Why It Matters"
http://m.huffpost.com/us/entry/doctor-patient-relationship-relies-human-connection_n_8296046.html

"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

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


Tweeted by @NEJMPerspec

"The Doctor's New Dilemma"
http://www.nejm.org/doi/full/10.1056/NEJMp1513708

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.

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


Tweeted by @THCBstaff

"Empathy and Shame"
http://thehealthcareblog.com/blog/2016/03/07/empathy-and-shame/

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.

[LinksEtc]

Tweeted by @hildabast

Improper & "potentially proper" biases? Ioannidis argues for assessing psychotherapies in properly-biased studies journals.cambridge.org/action/display...

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10224902&fulltextType=AC&fileId=S2045796015000888

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



@withyouDrWu tweeted a poster board ... I couldn't read all of it, but I'll post some info so others can look up later if they are interested ...

"Implicit Bias and Stigmatizing Language in Medical Records of Patients with Sickle Cell Disease"
Katie J O'Conor & others (couldn't read)
Johns Hopkins

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

[LinksEtc]

"How Only Being Able to Use Logic to Make Decisions Destroyed a Man's Life"

http://nymag.com/scienceofus/2016/06/how-only-using-logic-destroyed-a-man.html?mid=twitter_nymag

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.

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"Lady Gaga and the Life of Passion"
http://www.nytimes.com/2015/10/23/opinion/lady-gaga-and-the-life-of-passion.html?smprod=nytcore-iphone&smid=nytcore-iphone-share&_r=1

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.

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Tweeted by @doc_rob

"NONCOMPLIANT PATIENT-CENTEREDNESS"
http://more-distractible.org/musings/2016/3/30/noncompliant-patient-centeredness

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. 

----------


Tweeted by @HeartSisters

"How Minimally Disruptive Medicine is happily disrupting health care"
https://myheartsisters.org/2015/10/17/minimally-disruptive-medicine/

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.

[LinksEtc]

The patient called me a 'colored girl.'  The senior doctor training me said nothing.
https://www.statnews.com/2016/04/11/racism-medical-education/

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.

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"A Confession of Liberal Intolerance"
http://www.nytimes.com/2016/05/08/opinion/sunday/a-confession-of-liberal-intolerance.html?action=click&pgtype=Homepage&clickSource=story-heading&module=opinion-c-col-left-region&region=opinion-c-col-left-region&WT.nav=opinion-c-col-left-region&_r=1

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.

[LinksEtc]

Here is an example of the dangers of Google University.

"Science." You keep using that word. I do not think it means what you think it means.
https://www.sciencebasedmedicine.org/science-you-keep-using-that-word-i-do-not-think-it-means-what-you-think-it-means/

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.

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



However, I think a lot of docs have a hard time accepting that the Google-patient is sometimes right so here are some examples:

-----

"The DIY Scientist, the Olympian, and the Mutated Gene"
https://www.propublica.org/article/muscular-dystrophy-patient-olympic-medalist-same-genetic-mutation

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

&

epatients
how they can help us heal health care

http://e-patients.net/e-Patient_White_Paper_2015.pdf

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.

&


Tweeted by @mellojonny

"Why Doctors Sometimes Don't Always Know Best..."
http://thetriangulationofthought.blogspot.com/2016/05/why-doctors-sometimes-dont-always-know.html

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.

&


Tweeted by @joyclee

"A Mouse that Roared: Lori Alf's Fight Against Cancer and the Miracle Cure that Saved Her"
http://parade.com/474801/franklalli/a-mouse-that-roared-lori-alfs-fight-against-cancer-and-the-miracle-cure-that-saved-her/?utm_content=bufferd5be3&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

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.

[LinksEtc]

"What Google Learned From Its Quest to Build the Perfect Team"
http://www.nytimes.com/2016/02/28/magazine/what-google-learned-from-its-quest-to-build-the-perfect-team.html?smid=tw-nytimes&smtyp=cur&_r=0

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.''

Re: Communication and/or negotiation skills

I once posted that FAS is my "safe place" ...

Things are a bit different for me now that Links has gone semi-public, but still ...

I just love that special dynamic ...

I think we've shaken some of the biases of the FA community.


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


I think many patients no longer feel that there is enough psychological safety to talk about internet issues with their docs ... too many are getting labeled difficult, negative notes are being put in medical records, sometimes the docs complain about those pts online, medical care can be impacted.  The doc-pt relationship should be a psychologically safe place.

There is a certain trust involved when a pt tells a doc something in confidence.  Once that trust is lost, it is really difficult to get back.

Patients are still going to go online, but many probably will choose not to talk about it with their docs.  Online stuff may in fact be part of what influences their medical decision making, but many pts will just keep that to themselves rather than talking about it with their doc and risk that doc getting offended, annoyed, and/or angry.  I used to be open about my thought process concerning medical decisions with my docs ... now I often don't let them fully in.

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


To address bias, I do think humility is needed, at both an individual and community level, for both docs & patients.

Many docs think that it is absurd that a patient could be more right about a specific issue than them or that a group like ours may sometimes hold a more correct opinion than a place like FARE ... they are the ones with the medical degree / the medical board ... who do we think we are with our Google searches & social networking ... they are providing important social commentary ... we should probably stick to talking about recipes ...

and on the other hand, docs are rightly frustrated with all of the bad internet info out there and patients are harmed (sometimes killed) by such bad info ... docs are usually the ones with the more correct opinions regarding medical issues ... they have been through extensive training, often have years of clinical experience, they are the experts ... patients are often making bad decisions when they don't follow doc advice or when they go to (or listen to) quacks and/or lay opinion ... docs & places like FARE/KFA do rightly have a higher level of credibility, an intellectual leadership role.


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


Tweeted by @Flat_Jennie

"Cultural humility is different than cultural competence..." @PCORnetwork #BuildingTrust

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


What I think is that we shouldn't be at war ... we should be working together.

Docs can perhaps better see patient bias whereas patients can often see doc bias.  We need both perspectives.

[CMdeux]

Tweeted by @mellojonny


"Premature closure? Not so fast"
http://qualitysafety.bmj.com/content/early/2016/03/15/bmjqs-2016-005267.full

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.

I wanted to emphasize this point-- it is SO important.



THIS is how scientists operate and it's probably the thing about how Science Gets Done that is most alien to laypersons-- and this includes both healthcare consumers as well as physicians-- and even the best-intended and most conscientious of clinicians is seldom (outside of those who have BOTH MD and PhD degrees, not the combo) equipped to truly understand and embrace it.

Scientists must accept that their own interpretation/analysis is NEVER "The" answer.  To anything.  At best is it An answer... a POSSIBLE answer.   This is where statistics comes into things, btw...  because (and this is another thing that too many people outside of the sciences fail to appreciate) some answers are better than others, in that they are MORE likely to be true.

Again, these are things that the majority of patients and clinicians are not actually that accustomed to considering.  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.  Science means that when I finish the paper I'm writing, my peers-- starting with the ones that are "friendly" (being friends and colleagues) will shred it, looking to poke holes in whatever I haven't thought sufficiently about, revealing bias and underlying errors left and right.  Only AFTER that will outside reviewers be invited to do the same.    By the time a publication reaches print/'net, ideally, at least 5-10 people have gone through it, nitpicking all the way.  Now, it doesn't always happen the way that it should-- human institutions are great at becoming too human in the interests of feelings, social connectivity, etc.  but the PROCESS is pretty much ideal for dismantling bias and uncovering it where it's getting in the way. 

The public often misunderstands this process-- that is, when one paper says ONE thing, and then another says just the opposite, or something that seems contradictory.  Nope.  It's not that they "can't make up their minds" or that they "aren't so smart after all" it's that probably NEITHER set of authors is entirely, um-- right.  But also probably that both papers are 'true' insofar as the method and study design employed.    Everyone knows this-- or should.  Science is VERY messy, and nothing is ever "proven" with 100% certainty.  Statistics, again, can only point out what is most LIKELY to be so. 


That happens because the TRUTH is most important. 

It'd be great if physicians were trained to invite others to do this with their judgment and thinking, too.  Diagnosticians and specialists are better about it than GP's, generally speaking, IME.  But I think that might be because they see more complexity in their daily work, and it makes them understand that they don't always get the luxury of certainty.   

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

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.

The best clinicians realize this, if only intuitively-- and INVITE collaboration with patients and families and other practitioners.