Treat Me Like a Statistic but Please Be Nice to Me

Most patients would be horrified if their doctor said that s/he planned to treat them like a statistic.  This might be due to a wish on the part of the patient to believe that there is something specific about them that makes them less sick than the best statistical evidence would suggest they are.  If this is the reason, then the doctor is in a real pickle; s/he must try to give the best possible advice to someone who fundamentally doesn’t want to hear it.  But the horror might just come from a fear that a doctor who regards them as a statistic denies their basic humanity, which is something that people don’t like even if it has no effect on their health.  Of course this need not be the case; it is perfectly possible for a doctor to base treatment recommendations almost entirely on statistical information and at the same time to have the utmost respect for the patient’s irreducible dignity and individuality.  It would help a lot if doctors were better at conveying this distinction, and making people feel like they are individually valued even when the medical advice comes straight from the cookie-cutter.  Furthermore, patients might not always be wrong in thinking that a doctor who wants to treat them like a statistic really does devalue their  humanity; doctors who are sophisticated enough to understand evidence-based medicine need to be on guard against the temptation to use it as an shield behind which to hide any contempt for their patients that they might happen to have.  The imperative that medical advice should be based on sound statistical evidence doesn’t make basic niceness any less important.  Heads should be hard, hearts should be soft.

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  • Richard Hollerith

    Compassion is a very nice virtue, but IMO the most important virtue of the heart is courage.

  • Richard Hollerith

    –courage in service to truth, as opposed to, e.g., courage in service to personal or national aggrandizement.

  • http://www.hopeanon.typepad.com Hopefully Anonymous

    Great post. I love that you’re helping to destroy a dialectic (statistical evidence-based medicine vs. compassionate personalized medicine) with this writing in a way that has the potential to enrich us all. Lines like this are great progaganda “It would help a lot if doctors were better at conveying this distinction, and making people feel like they are individually valued even when the medical advice comes straight from the cookie-cutter … Furthermore, patients might not always be wrong in thinking that a doctor who wants to treat them like a statistic really does devalue their humanity; doctors who are sophisticated enough to understand evidence-based medicine need to be on guard against the temptation to use it as an shield behind which to hide any contempt for their patients that they might happen to have” in that the appropriate touchy-feely challenges to evidence and statistic based medicine.

    However, it is an empitical question how nice statistically we need doctors to be. It may be that maximum benefit might accrue with something less than the level of niceness and compassion most people desire from their doctors.

  • joe

    HA,
    ” I love that you’re helping to destroy a dialectic (statistical evidence-based medicine vs. compassionate personalized medicine)”
    I think you completely missed the point. His post was not about EBM versus compassionate personalized medicine. Notice the second to last sentence of Balan’s post
    “The imperative that medical advice should be based on sound statistical evidence doesn’t make basic niceness any less important.”
    The post is not about how they should be treated medically (it seems to be taken as a given that EBM is the way to go); instead, it seems to be about how the doctor should treat them on a personal level while using statistics to guide their treatment.

  • http://www.borlik.net/blog/ Jeff

    There are some areas of medicine where progress is being made, and statistics (survivability, etc) based on pre-breakthrough outcomes are not relevant any more. For that matter, doctors with many years of pre-breakthrough treatment might unintentionally underestimate the patient’s outcomes. (Is that another bias to overcome?)

    I don’t say this to dispute your point, but rather to note that it is sometimes really hard to find the right statistics.

  • http://profile.typekey.com/robinhanson/ Robin Hanson

    I agree that many feel doctors do not treat them with enough respect, but I don’t think this has much to do with treating people like statistics. Doctors are among the least statistical people around. Instead doctors are mainly just self-absorbed in doing what they see as their job, and don’t see being more “nice” as that important. And in fact the incentives they face do not much reward being more nice.

  • Douglas Knight

    Robin Hason,
    There are complaints about “treating people like statistics,” so it seems worth knowing what prompts that reaction, at least if the complaints reflect real motivations. Moreover, the complaints may increase if doctors and newspaper stories about doctors start using the word “statistics” more, regardless of relevance. This may be an advantage of the word “evidence.”

    Jeff,
    what areas are you talking about? It takes long trials to get drugs approved, so you can always quote those. They may underestimate the benefit if there’s a real “break-through” whose effects go long beyond the trials, but I’m skeptical that any such areas exist. The best guess I can come up with is statins, but for them it seems that you can use old cholesterol tables.

  • http://entitledtoanopinion.wordpress.com/ TGGP

    What does it mean to “deny someone’s humanity”?

  • Michael Sullivan

    It seems to me that one colloquial meaning of “treating X like a statistic” is to ignore or not bother to discover relevant information about the individual. If that information is useful and already in existence or of great significance yet not costly to discover, then treating a patient like a statistic in this sense is hardly an optimal bayesian strategy. Yet this certainly happens in medicine. It’s not uncommon for a doctor to see X, Y and Z and immediately assume A based on what would be sound statistical reasoning in the absence of any other information. But sometimes they will do this even when information W is available and immediately puts A in doubt despite X Y and Z.

    I’d like to think that people who use “statistics” in their decision making will be optimal bayesians, but in practice, there is a tendency even among scientists, and moreso among technicians (such typical non-research MDs) to gloss over important individual data once we’ve identified a general trend. I can’t put my finger on exactly what this bias is, but it has to do in my head with a either/or bias. A bias toward yes/no answers. So the fact that some 70% correlation is very clearly demonstrated with a very high confidence, leads us to often gloss over that in any individual case, using that correlation to make a prediction gives us a 30% probability of error.

  • Jor

    As someone in training at an Academic Medical Center, I don’t think EBM is really controversial any more — at least for the current generation of trainees. It also isn’t as simple to treat an indvidual patient as a statistic as you would think at first blush — even with the tons of data available(e.g., c.f. Limitations of Applying Summary Results of Clinical Trials to Individual Patients)

    Furthermore, a lot of what doctors do intuitively is already statistically based — most of it is pattern recognition. I don’t think the problem is statistics de-humanizing patients, but more-so partly self-inflicted disease, induces disgust, which biases the heuristics and thoroughness of physicians. Or at least, that the point I’m getting from Groopman.
    So although physicians are screened for intelligence, there is no effective screen for empathy. The point that caring is as important as technical skill or intelligence isn’t even controversial, as its a point made by leading physicians as long as medicine has been around.

    The other point I would make on doctors and empathy is that there really is no effective way to tell how empathic/caring someone is when they are applying to medical school. There are “surrogates”, but these can be easily gamed by anyone smart enough to get into medical school in the first place. At one point, people thought humanities majors would be more empathic, but that didn’t wind out really panning out.

    I think it’s hard for someone who is not in the health-care field (actually providing care to patients, i.e. nurse, doctor, EMT, etc.) to understand the disgust partly self-inflicted disease brings out in people. The only analogy I can think of would be the lack of response most people have when they walk by homeless people, most of whom aren’t just their on because of wrong choices they made, but also because of a serious mental illness (schziophrenia).

  • Douglas Knight

    It also isn’t as simple to treat an indvidual patient as a statistic as you would think at first blush

    For fifty years people have been designing protocols that do better than physicians. It’s basically trivial, a lot easier than I expected, at first blush. Getting physicians to follow the protocols is the hard part. The problem is that it would dehumanize the physicians, and they, unlike the patients, have the power to stop their dehumanization.

    Yes, Michael Sullivan, we shouldn’t just shove statistics at doctors. They don’t even understand false positives. But the problem of what they should do is solved.

  • http://gopalcamp.blogspot.com/ Gopal

    I wholeheartedly agree that compassionate care and practicing evidence- (and statistics-) based medicine are not mutually exclusive. Both are essential elements in delivering effective health care. As far as doctors learning more statistics, hopefully this is something that will come with time and humility. I am a medical student and I have blogged on this subject before:
    http://gopalcamp.blogspot.com/2007/08/how-doctors-think-they-think.html

    Cheers
    Gopal