Healthcare in the United States is a mess. As a physical therapist, I have experienced frustrations on the patient and provider side.
It’s not hard to poke holes in the system, it’s hard to fill them.
“Never ask the doctor what you should do. As him what he would do if he were in your place.” — Gerd Gigerenzer
Information gaps are common
One of the primary issues in healthcare today is information gaps. There is a concept known as knowledge translation. Essentially, it is the process of taking information from research (labs, journals, conferences) to healthcare providers and patients. It is the act of putting research to practical use. To put it bluntly, we are terrible at this in the United States.
You may be inclined to believe this shouldn’t be a challenge. Why wouldn’t a clinician, whether it be a physician, physical therapist, nurse, or other healthcare professional be able to easily stay up-to-date in the evidence and provide appropriate treatment? Is that not what we go to school to learn? Wouldn’t using the latest and greatest evidence help clinicians achieve their ultimate goal of making the lives of their patients better?
While there is a large gap between the scientist and the provider in the field of healthcare, there is a larger gap between the provider and the patient. The latter is largely due to a concept known as information asymmetry.
“When sellers know more than buyers, buyers must beware. It’s no accident that people in the Americas, Europe, and Asia today often know only two words of Latin. In a world of information asymmetry, the guiding principle is caveat emptor — buyer beware…Imagine a world not of information asymmetry, but of something closer to information parity, where buyers and sellers have roughly equal access to relevant information. What would happen then? Actually, stop imagining that world. You’re living in it…Buyers today aren’t ‘fully informed’ in the idealized way that many economic models assume. But neither are they the hapless victims of asymmetrical information they once were. … The belief that ‘sales’ is slimy, slick, and sleazy has less to do with the nature of the activity itself than with the long-reigning but fast-fading conditions in which selling has often taken place…The balance has shifted. If you’re a buyer and you’ve got just as much information as the seller, along with the means to talk back, you’re no longer the only one who needs to be on notice. In a world of information parity, the new guiding principle is caveat venditor — seller beware.” — To Sell is Human by Daniel Pink
Information asymmetry is when one party (the healthcare provider) knows more than the other (the patient). This can lead to an altered power dynamic that is prone to many consequences.
In a perfect world, the provider uses their advanced training and experience to provide appropriate education and treatment to help a patient achieve their goals.
Unfortunately, that is not the world we live in and it is not a dichotomous situation.
The world does not consist of two types of providers: ethical providers with the patient’s best interest at the forefront and unethical providers seeking to maximize profit and the expense of the patient’s well-being. This a spectrum with many possibilities. Additionally, not all issues result from information asymmetry. This is where cognitive biases come into play.
Providers have gaps too
As I mentioned, the gap between research and providers is large as well. Providers are bombarded with information and expected to memorize and regurgitate it all. This is not meant as an excuse, I am simply relaying the state of the current system.
Aside from understanding research, it is challenging to know what research to implement in clinical practice.
How many studies are needed before we can confidently apply new information? Is low-quality research acceptable? What if the patient demands a treatment that is known to be primarily placebo or possesses a high risk of side effects? What if our years of personal experience differ from the results of a couple of small research trials?
Translating research to clinical practice is not a simple process.
“Digital misinformation has become so pervasive in online social media that it has been listed by the World Economic Forum as one of the main threats to human society.” — Annual Review of Public Health, 2020
Healthcare needs to become a team sport.
Appointments with providers should not be rushed affairs. There are many blind spots providers fall victim to if they do not understand their patients.
My evaluations are never complete after a single treatment visit. Part of the evaluation is seeing how the patient responds to treatment.
We change daily. Every time a patient comes to my clinic, they are a different person. It could be a difference in stress levels, understanding of their pain, or the last meal they ate.
The only way for us to close information gaps is to have conversations. Providers need to abide by the research and share their thinking. Present the patient with risks, benefits, and current research. Patients can then make informed decisions.