I’m sitting outside a cafe in a placid northern Michigan town. At the next table is a group of boaters up from the harbor for a cup of coffee. Mothers are strolling by with their toddlers, the men having returned to the city for the work week. (For some reason, I’ve never seen the opposite up here…recency bias? I don’t think so, but it’s very difficult to detect one’s own cognitive biases.)
When considering one’s own health, we are all susceptible to these biases. We tend to be overly optimistic, count our own experiences above the pooled data of many individuals studied statistically, and tend to think that chance events are perhaps not so random. In sum, each of us thinks we are unique.
Of course, we are. However, when making decisions about one’s health, it is wise to bow to the power of statistics. Betting with your heart is not always as good as betting with your brain.
This isn’t to say that individual patient’s experiences are meaningless. If a medication makes you ill, then so it does. But patients wander into the woods of medical decision making alone at their peril.
Most doctors trained in the last 15 or 20 years are familiar with “evidence based medicine”. Rather than “guess” at what might help our patients, we look at data, especially from randomized controlled trials, to make decisions about what treatments are most safe and effective. This has been a nearly–but not quite–immeasurable improvement in how we treat people. (Drug-testing is a source of controversy in and of itself…read this).
I can’t tell you how often I hear things like, “I know you say it’s a virus, but I know that I need antibiotics.” Part of the problem is communication, part is education, but most influential is a person’s inherent belief in their own ability to make decisions with the available data, ignoring the larger body of evidence. In the hands of one patient, this fallacy is dangerous to perhaps one or two people. In the hands of a physician, it is dangerous to many more.
In an ideal medical world, all doctors know all the data, and all patients are able to evaluate the lay-equivalent literature. But I can tell you that when someone comes to the doctor, they want to feel better. They don’t usually care about data, and they don’t want a reading assignment. A good physician must assess the patient’s personality and strike a proper balance between autonomy and paternalism.
When people turn to “alternative medicine”, it is often perceived as a condemnation, a failure of medical science to communicate properly with patients. This is not exactly true. Alternative therapies appeal to people’s basic ability to recognize patterns in themselves, to respond to their own internal cues. We, each of us, know ourselves better than anyone else, so why consider evidence, statistics, studies?
Why indeed? As a patient who knows evidence based medicine, I am as susceptible to my own biases as any other patient–which is why I am not my own physician. I am familiar with the data, and have seen thousands of patients, and I can say without qualification that I would put my health into the hands of a knowledgeable physician ahead of peddlers of quackery, no matter how seductive. I wish to live a long and healthy life, and have no intention of turning to unproven “therapies” in hope of obtaining a more “holistic” outcome, whatever the hell that means.
Remember, when you make health decisions, that no matter how much you know something, you may not know the other “somethings” that make the difference between sickness and health, life and death.
