Saturday, March 4, 2017

When doctors know that they don’t know - The Boston Globe

Imagine that you are a medical doctor. You need to tell one of your patients that he has advanced-stage pancreatic cancer, an almost incurable condition. You learn that your patient's only daughter is getting married five months from now. Without treatment, your patient has about a year left to live. Chemotherapy would increase his chances of being alive in five years by about 20 percent but would also double his chances of dying before his daughter's wedding. What do you tell him? Of course, the choice is by no means easy or clear-cut.

Doctors are scientists who operate in a world of statistics, odds, and probability. Yet they've long been taught that when dealing with patients they should convey a reassuring level of confidence and certainty. As a result, patients expect their doctors to give them a clear diagnosis and a straightforward course of treatment.

But now that information about every medical condition imaginable is just a few clicks away, experts are asking whether doctors' apparent certainty when communicating with their patients actually does more harm than good. With the information overload brought by the progress of medicine and technology, answers are rarely black or white. Medical schools are only just starting to teach doctors how to deal with this, and patients' expectations haven't adjusted, either.

The fact is that medicine has long been steeped in uncertainty and has arguably even thrived on it. To avoid bias when testing a new drug, researchers must have no preconceived notions of which treatment, the new one, the old one, or even a placebo, is the best option. This principle, called equipoise, protects patients, doctors, and researchers alike from making assumptions before scientific proof of efficacy has been gathered.

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