One lesson of the past decade is that facts - scientific and medical - aren't always clear. Rather, they're messy and often difficult to interpret, even upon expert examination.
How we make medical decisions - amidst confusing, conflicting and sometimes contradictory information signals - is one of the biggest health care challenges for the years ahead.
Now, there's a vast volume of health information available to patients and doctors, both. We're immersed in data, directly delivered by the Internet into our homes. We can access reams of raw, un-spun research results; these turn up in government-funded, transparency-directed databases and in the on-line supplements to serious scientific journals. At the other extreme, we can take in processed, neat-and-tidy bits of medical knowledge from commercials and TV docs.
Patients are more informed and in some ways more vulnerable than ever. Real information intimidates and confuses; the packaged version reassures and lets us take control. It's far easier to choose the latter, although it may not be true.
A half-century ago, a medical problem was a doctor's dilemma. If you visited a physician with an aching joint, he would decide whether you should take medicine, undergo further evaluation for rare forms of arthritis, or just leave it alone. If you had pain in your chest, he would determine whether the symptom was sufficiently worrisome that you should go to the emergency room for an EKG and treatment, if told. If you were pregnant, the doctor would indicate what arrangements should be made for delivery, and you would follow carefully his instructions.
Today, many adults are understandably wary of physicians' advice. Long-standing relationships between patients and doctors are scarce, if not unusual. Trust comes in knowing a person well and over time, an aspect of medical care that's lost when insurance plans change and further damaged by a breed of younger physicians who, with a keen instinct for self-preservation, may sensibly choose to limit the hours they work rather than quit the field entirely.
Emergency care by specialists - each with treatments to sell, only some which can truly help - coupled with a paucity of primary care-givers, leaves many people confused, without a familiar face when they confront pneumonia, cancer, a heart attack or stroke. It's hard to make important decisions when you don't really grasp what's wrong, you don't understand the options, and you're unfamiliar with the doctor who's trying to help.
Trust in doctors is eroded, further, by news reports of physicians' conflicts of interest. Even if only a few physicians abused their academic authority by quietly accepting funds from drug companies and then subtly shifting their research publications, textbook chapters and presentations to mesh with those businesses' ends, the story's out - for good.
The concept of an informed patient - one who's knowledgeable about his or her condition and engaged in health decisions - might solve the problem, at least in principle. Information empowers, we all agree. But is it enough for a patient to stand on, alone? I doubt it; I think it's hard enough for doctors to keep up with medical news, even in their specialty.
No matter how this plays out, we've got a new dynamic in health care - an open, modern discussion between patients who, every once in a while, know more than their physicians and, often, understand that what they know matters, too. Communication in medicine is a work in progress.
I'm eager to see how the process moves forward, and wonder what paths it will take.
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