Monday, November 07, 2011

What The Doctor Saw

I recently finished reading What the Dog Saw by Malcolm Gladwell. I enjoyed the book, although it's more a collection of essays rather a unified work like his prior works. Why mention it here? Well, one chapter/story heavily involves mammography. The chapter is actually two stories in one, but both basically relate to the premise that a picture is worth a thousand words... but are they the right thousand? The other story involves the use of satellite imagery by the U.S. military to assess foreign targets. Malcolm Gladwell compares this to a mammographer scanning for tumors on a mammogram. The analogy is reasonable... but like all analogies, it breaks down after a while.

So, what does Gladwell conclude? Honestly, it is kind of hard to tell. He notes the difficulties in mammographers being over- and under-sensitive, yet concludes by noting the benefit of mammography spread across the population. What I wish he had taken more time to address would have been the nature of a screening exam. What does it mean for an exam to be 'sensitive'? 'Specific'? I'm willing to bet the vast majority of people out there don't know. Heck, I imagine many people within medicine aren't 100% clear. The recent controversy over prostate screening guidelines highlights just how controversial this subject is. If healthcare professionals are not united in how such screening is presented to the public, how can we expect patients to choose the right course of action? Furthermore, in the long run, such revisions erode the public's trust in healthcare overall.

How do healthcare professionals strengthen this trust in an era of seemingly constant changes in recommendations? Simple: focus on the underlying reasoning behind getting screened. Explain to patients that such tests evolve over time as new technologies develop. Help patients make informed decisions on their own. Ultimately, the better we communicate the need for testing, the benefits *and* the risks, the better relationship we will have with our patients, and hopefully they will enjoy better health in the long run.

What do you think? Check out the book to see Gladwell's argument yourself... you might find yourself enjoying his other pieces as well!

Just want to read the chapter but not the whole book? Gladwell has it posted on his website here.

Site Note: Regular readers may have noticed the long pause in new posts. Apologies, but sometimes life comes at one fast... and the blog got pushed to the backburner. Again, thanks for sticking with us and we look forward to putting up lotsa great new Scrub Notes stuff shortly! Happy reading!

Updated 2015-12-20

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