Practicing clinicians contain multitudes: the vastness of critical medical knowledge applicable to the nearly infinite permutaions of individual patients. However, lost in the shuffle is apparently a grasp of the basic fundamentals necessary for shared decision-making: the risks, benefits, and harms of many common treatments.
This simple research letter describes a survey distributed to a convenience sample of residents and attending physicians at two academic medical centers. Physicians were asked to estimate the incidence of a variety of effects from common treatments, both positive and negative. A sample question and result:
The green responses are those which fell into the correct range for the question. As you can see, in these two questions, hardly any physician surveyed guessed correctly. This same pattern is repeated for the remaining questions – involving peptic ulcer prevention, cancer screening, and bleeding complications on aspirin and anticoagulants.
Obviously, only a quarter of participants were attending physicians – though no gross differences in performance were observed between various levels of experience. Then, some of the ranges are narrow with small magnitudes of effect between the “correct” and “incorrect” answers. Regardless, however, the general conclusion of this survey – that we’re not well-equipped to communicate many of the most common treatment effects – is probably valid.
“Physician Understanding and Ability to Communicate Harms and Benefits of Common Medical Treatments”
http://www.ncbi.nlm.nih.gov/pubmed/27571226
There couldn’t be a more glaring example of “denialism” than Dr. Radecki? An absurd, long-running disavowal and pigheaded obstinance in the face of overwhelmingly accepted, consensus and compelling clinical evidence of treatment benefit for eligible stroke patients treated with t-PA. With trials, data and additional evidence since 1996? The irony that he practices at an institution that is among the nation’s top hospitals in stroke treatment…Dr. Grotta no less (which means they believe it) is absolutely bizarre! Stroke patients in the ED should be given informed consent and allowed to select another ED physician.
“Our faculty administers t-PA more often and more effectively than most hospitals across the nation. A long history of careful research and experience to expand treatment options for t-PA use”
– UT Stroke Treatment Acute Team
Denialism (From Wikipedia)
“In the psychology of human behavior, denialism is a person’s choice to deny reality, as a way to avoid a psychologically uncomfortable truth.[1] Denialism is an essentially irrational action that withholds the validation of an historical experience or event, by the person refusing to accept an empirically verifiable reality.[2] In the sciences, denialism is the rejection of basic facts and concepts that are undisputed, well-supported parts of the scientific consensus on a subject, in favor of radical and controversial ideas.[3]”