Saturday, March 8, 2014

Doctor Bashing

Dear Readers,

Let us talk of the popular sport called "Doctor Bashing".

It is rife in the media, amongst patients, health practitioners (alternative and allied) and, let's not forget, lawyers. Doctors have been vilified as ignorant and blind to economic realities. We have been labelled as expendable and replaceable with algorithms.

Even better, are blithe remarks like this one by Alex Green, wealth author and weight loss columnist:
The best medicine, of course, is preventative. Unfortunately, too many doctors are inclined to prescribe a pill rather than a healthier diet.
Market forces would dictate that demand usually determines supply.  Doctors (amongst others) will tell you the basic principle of weight loss is: "Less energy in!! More energy out!!". Basic maths, folks. But as soon as there is a hope of an "easy" cure, a miracle in a pill form... the rest of the advice is conveniently forgotten. The same doctor-bashing patients flock: "I could lose weight by taking this pill? And I don't have to stop eating??". Give me the pill! With fries!

It's easy to vilify doctors. Like teachers, we are seen to be keepers (sometimes, accused as withholders) of knowledge, softies for a good cause, confusingly committing years of study and accepting decidedly less pay than what we could have earned privately or in other sectors, all "for the benefit of mankind". We make choices voluntarily to help others. Like teachers, we have responsibilities to current and future generations. And like teachers, we have somehow become the cellar-dwellers of society and yet, we are one of its most important building blocks.

New colony on the Moon? Really? They're not going to put a stockbroker, or magazine editor up there? They want whom?

When it comes to health outcomes, particularly obesity, the need for patients to acknowledge their role on the demand side is palpable and critical.

The completely befuddling thing is that most people realise the consequence of years and years of flagrant spending without saving. Even with the presence of a credit card, which helps to bring the consequence home sooner, spending without saving becomes a bit of a drag. It's also basic maths. Reasonable people don't turn up to the doorstep of their banks and accountants after years and years of such behaviour and demand that they "SHOW ME THE MONEY!!!".

It is a curious thing that when the health equivalent shows up: the obese, smoking, hypertensive, hyperlipidaemic, diabetic, non-exercising, non-medication compliant patient turns up in Emergency with crushing left-sided chest pain, their family members turn to the emergency physicians and say: "Do everything you can! Please don't let him die!".

Preventative health is critical. Doctors have been focused on treatment and "unhealthy" management because that is where the demand for their supply is most critical. The shift towards incorporating preventative health is here. For success, it requires joint cooperation (and mutual respect) between doctor and patient. Just basic maths, folks.

Joint effort for Patient-centric Medicine

Much is spoken of patient-centric healthcare, providing more information to the patient, the coming revolution in doctor-patient / doctor-paramedical relationships.

Robin Farmanfarmaian, of Exponential Medicine, writes about the emerging shift in healthcare - the shift to patient-driven healthcare and "joint effort". The foundation of this patient-driven healthcare evolution is access: the increased access to up-to-date information via tools, gadgets, platforms and programs. This spans access to their own biometric data, access to information resources on their diseases as well as increased access to practitioners. 

Critical to this is each patient's knowledge on how to access it and their ability to use the information once obtained. For example, did you know that the Cleveland Clinic offers an online service called "My Second Opinion"? Using this service, people from around the world can tap the knowledge of Cleveland Clinic's specialists in the USA to seek another assessment of their diagnosis, investigation or treatment.

Why is this important? 

The other important piece of a joint-effort pie is provider of health information. The Doctor, and the role of the Doctor, has taken some battering in recent years. Watch this video from Stanford Medicine X of Vinod Khosla, who highlights the shortcomings of doctors and the art of solo-effort (and even team-effort) diagnosis.

The exact quote that Mr Khosla references in part during his talk is:

“There are in fact two things, science and opinion; the former begets knowledge, the latter ignorance.” ― Hippocrates
My interpretation (opinion!) of this is the level of humility both patient and doctor must retain when casting an opinion on the profoundness of the disease. An opinion implies certainty, but as Nassim Taleb asserts in his book "The Black Swan", it is the temptation, the arrogance of certainty that blinds you to the possibility of other explanations. 

Patients are looking for certainty and consistency, both of which arise from the assumption that medicine, as a science, can provide both. This also implies their desire of exactness, singular explanations and the absence of grey. Much like a simple math problem, eg 2+2, it is assumed that when abiding to the rules of arithmetic, the result must always be 4.

But Mathematics is a language, and is thus also an art. It has levels of sophistication and complexity. There can even be widespread debate and consternation on the seemingly simplest of problems. In part, thus, it governed by rules but is opened to interpretation, based on the skill and prior experience of both speaker and listener.

The same has been argued about Medicine being a science and an art. 

Why might people receive multiple different diagnoses, investigations and treatment plans? It is because the application of different skill levels and prior experiences of different doctors to the solution of a range of simple to complex problems will naturally lend different perspectives on the identity and solution of the same problem. 

Which means doctors need to collaborate with other doctors (read: all health practitioners) as well as patients to deliver on this patient-centric medicine. 

Labels