How Can Medical Experts Disagree? Written by Dr. Flint

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Dr. John Flint wrote the article: How Can Medical Experts Disagree?, which was featured in the December 2015 edition of the Flagstaff Business News.

As a patient and a provider I have been fascinated at how medical decisions are made.  As you have surely noticed the medical world seems to take one step forward and two steps to the side when it comes to new recommendations on things like mammograms or PSA screening.  Often experts disagree, vehemently, over the recommendations.  It begs the question of how experts reading the same scientific studies can disagree over recommendations or treatments.  How can two well trained specialists disagree over a surgical recommendation or chemotherapy regimen?  

Two physicians, Dr. Groopman and Dr. Hartzband, have studied and written about this very phenomenon. In the spirit of the great American physician William Osler, they listened to patients regarding their values and perspectives.  They found that there were some basic mindsets that recurred again and again in the thought processes of patients.  On the scale of willingness to institute or undergo treatment they found a large group that wanted the minimal treatment, termed minimalist, and a large group that wanted the most treatment possible, termed maximalist.  In terms of the nature of the intervention people were categorized into two large groups--those that preferred natural treatments, termed naturalism, and those that preferred scientifically produced medical treatments, termed technology.  The researchers also found that people could be grouped in their faith or confidence that the prescribed medical treatment, be it natural or tech, be it minimal or maximal treatment, would be successful. They termed those with high confidence in the medical treatments believers and those with low confidence in the success of the recommended treatment doubters.

Thus the researchers found different paradigms at how they looked at their treatments, desire to undergo treatment, and where they placed their faith.  Importantly, they also found expert physicians have biases regarding the efficacy of treatments and interventions due to their experience with those treatments as well as their inherent mindsets.  Thus, some physicians will view the data and scientific studies available to all physicians with the maximalist and believer lens, while others reading the same studies will view the data through a minimalist, doubter lens.  So, we return to our original question of why experts disagree?   We can now see that when medical societies or experts sit down to make recommendations regarding treatment they do so with their particular set of lenses on that are part of their intrinsic nature.  With different lenses, experts produce different recommendations.

Likewise, patients find themselves looking through the same lenses of maximalist vs minimalist, believer vs doubter, naturalism vs technology.  Thus, some patients with the same condition will choose very different treatments due to their lenses/paradigms.  Thus, there is not necessarily a right answer to be applied to every patient.  The patient’s values and the paradigms or lenses they use are critical to making the right decision for the right patient.  

So as you meet with your physician think about what lenses you look through so that you can more clearly understand your values and how they bear on the diagnosis you are given and more importantly the options for treatments you are presented.  You should also consider the lenses that your physician is looking through.  As you recognize these elements in the process of deciding upon treatment, you can make sure that it is a shared decision that both you and your physician are actively engaged in.  It will help you make a shared decision that is right for you, and not just what the books or experts say. 

Dr. Flint has worked extensively on issues related to health policy, medical education, and legislative issues pertaining to orthopaedic patients.  He specializes in surgical and nonsurgical treatment options of the hand, elbow and shoulder. For additional information or to schedule an appointment visit www.flagstaffboneandjoint.com or call 928.773.2280.  Flagstaff Bone and Joint is located at 77 W Forest Ave. (in the Physicians & Surgeons Offices attached to Flagstaff Medical Center).