Our Own Biases (December 8, 2015)
“Experts” and laypersons view new medical evidence through the lens of their own biases. That being said, it’s important for patients to consider their physicians’ biases in the context of their overall health.
It’s not I who said that, although I bet I could have if I’d worked at it for a while. That is Dr. Kenny Lin, a very smart guy with a resume longer than my car’s repair history, and he makes several important points in those two sentences. Points which should be taken to heart by anyone who, for whatever reason, ever gets within scalpel-length of the American medical/health care system.
To begin with, note that although Dr. Lin is telling us that we and our doctors are biased, his solution is NOT to go out and try to find an unbiased physician. That is not only because there is no such thing (any more than there is such a thing as an unbiased news source). It is also because your doctor is not in charge of your health care anymore. Dr. Lin is dumping responsibility for the patient’s health right where it should always have been – on the patient him/herself.
Your doctor’s word was never law, of course. But everyone -- including the doctors themselves -- used to act like it was anyway. So it is a source of great satisfaction to me that in the last 20 years or so, much of the paternalistic and patronizing attitude that was present as a matter of course in medicine has vanished.
Well, ok, it hasn’t actually vanished – it’s still around and often disguised just as badly as that pair of eyeglasses disguised Superman. Still, instead of being expected to simply listen and obey, the patient is now empowered – and thus expected -- to make his/her own health care decisions.
We will leave out the obvious fact that when an insurance company can nullify any or all of your health care decisions at any time, you are not truly empowered. What I mean to say is that in place of the old-fashioned method of your doctor telling you what to do and getting all bent out of shape if you didn’t do it (especially if you were female), you will now be consulted as to which of several available options you prefer and be expected to make that decision. Hence Dr. Lin’s admonition to take physician bias into account when you do this.
The definition of bias is “prejudice in favor of or against one thing, person, or group compared with another, usually in a way considered to be unfair”. Any expert is going to be prejudiced in favor of what is provided by their own field of expertise, and no matter how honest and how fair s/he may be trying to be, their personal experience and education (and self-interest) is going to skew their opinion in a particular direction.
Medical facts can be surprisingly fluid, and many things that were once set in stone are now up for grabs. The number of available choices that often result from this factual vagueness is not at all a bad thing. So you must try to keep in mind that however expert a physician may be in their specialty, outside of that specialty s/he may know jack spit about the alternatives.
Back to Dr. Lin, don’t miss that he speaks of patient as well as physician bias. It is my doctorly opinion that people are often less aware of their own biases than they realize. Or maybe it's that we just don't recognize them as biases per se. There is nothing wrong with being biased, especially when your bias is based on personal knowledge of yourself and experience rather than, say, a commercial you just saw. But you must include awareness of your personal bent in your decision-making, or you can wind up in the soup without even the satisfaction of being able to blame someone else for it.
Just because bias exists and is unavoidable does not mean that you can’t get factual information on health and make a good decision with it, if that’s what you want. And factual information certainly is something that you should want if you value your health. There have been some genuine attempts to remove as much bias from the system as possible, hopefully leaving behind reliable information. Evidence-based medicine is probably the best of those attempts.
Evidence-based medicine is a 20-some-year-old movement to thoroughly evaluate published research on medical conditions and treatments and sort out which treatments have evidence supporting them and which don't. It has a limitation that you can see right away in the definition – “what’s been published”. Perfectly good research may never see the light of day for many reasons, and if it’s not published, it will never make it into evidence-based guidelines. Plus, research may be insufficient to answer a question, or it may be completely nonexistent in a particular area. So as useful a starting point as it can be, it is usually only a starting point. But I do think that it should be everyone’s starting point.
(Speaking of a slightly different type of bias, I would like to mention something that is not particularly nice. How you appear to your medical professional has a whole lot to do with how you will be treated and which options will be presented to you. As examples, a black man will be treated differently from a white woman, and someone obese will be treated enormously differently from someone who is not. This is sad but true and anyone who is a patient in the system needs to be aware of it.)
So this is the thing. Don’t just do what your doctor wants you to do. And likewise, don’t just do what you feel like doing. Start with what genuine information is available on any medical or health condition you are dealing with, and take it from there. That’s a lot to ask of someone who is not a medical expert. But it can be done, especially if you aren’t shy about asking questions.
My recommendation is that you start with what is generally known and understood about a condition and its treatments. Then get information from other sources, especially from people with integrity who know more than you about the subject. And use at least a minimal amount of your own judgment in processing it all. Once you’ve done all that, feel free to be biased. Everyone else is.
--dr. diane holmes
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