April 5, 2014

Medical Community Has Common Bias

This common bias often means that patients are ignored and families of patients lose, often meaning the lives of loved ones. Sources on the internet are rich with examples of this bias. This blog by Jessie Gruman is a great one on overall health. I will be using it for diabetes.

The extent to which physicians, nurses, health plans and employers overestimate their patients' knowledge about diabetes health concerns:

  1. Physicians greatly overestimate patients' knowledge of process of informed consent and what they are signing.
  2. Doctors and nurses often overestimate their patients' health literacy and more often literacy in general.
  3. Doctors overestimate the amount of information they have given to patients about a prescription drug.
  4. Many diabetes websites for the public assume a grade 9 to college sophomore reading level and a master's degree in comprehension level.
  5. Many patients don't know the location of the organs their diabetes affects (e.g. pancreas, heart, kidneys).

These same doctors will discourage patients from researching on the internet. They are more concerned about all the misinformation on the internet. Yet, these doctors with over inflated egos are incapable of carrying on an honest communication with their patients. This is a lose – lose situation for their patients.

The effects of this bias and overestimation of our knowledge are profound. This bias leads to a shortage of information we need, not just how or if we learn it. Health literacy is short-changed and confusion is promoted. With most “Ask a Nurse” programs no longer in existence because of the trite answers of, “Go to the emergency department,” to, “Set up an appointment in the morning,” is it not surprising retail and walk-in clinics are thriving.

This same overestimation shows up in the information sheets we receive for surgery preparation. Many of us remain well for quite a few years and often run into the problems when we first need to care for a parent or other relative. Others first encounter problems when we are diagnosed with type 2 diabetes and other chronic conditions, such as cardiovascular disease and hypertension.

Then, as we seek care, we seldom find the knowledge we need to care for diabetes and related health care. It is no wonder it takes us some time to find the information to accomplish our diabetes care tasks efficiently and effectively. As more things are discovered affecting our diabetes care, making it more complex, the responsibility falls to us to keep abreast of these changes.

As the above increases, our doctors fall farther behind and cannot keep up with the latest developments and we are left more on our own. Doctors are reducing the length of appointments and checking less to see whether we are managing our diabetes in a systematic method. They prefer to only look at the A1c results and add more medications for us to take. These medications have more and sometimes severe side effects, but we have them foisted on us with no explanation.

When we dare ask about insulin for better diabetes management, we are chastised for failing to manage our diabetes with oral medications. Some doctors also say that using insulin is our punishment for failing to manage diabetes with oral medications. What they don't realize is that patients are beginning to wake up and realize this says they have not stayed current and do not understand insulin. They do not understand how to determine dosage and even less about preventing hypoglycemia.

The overestimation bias in health professionals and other experts prevents them from truly recognizing the depth of this problem. They can't see our need for knowledge and this prevents them from allocating the resources to solve it. Maybe in our current cost-conscious environment, the cheap old "let 'em sink or swim" approach is preferable to addressing a well-known, well-documented bias that prevents our participation in our own care of diabetes.

What they fail to recognize is that we are, after all, a rather resourceful bunch as patients. Many of us will figure it out. However, there are many, who, for a variety of reasons, simply lack the resources to persist until they are both competent and confident to manage of their diabetes. This is the reason to trust people with experience and to search out empowered patients and utilize them. We, as patients, need to understand that what works for one person may not work for another person.

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