Patients indulge wishful thinking in medicine

We humans are a species of animal that tends to look for the hopeful side of anything, especially when addressing our health.

A new meta-study conducted at Bond University in Australia finds that most patients are unreasonably optimistic about the potential benefits and the risks of medical procedures.

“What struck us is that, in general, people thought that treatments were going to be much more beneficial to them [than the evidence suggested],” says researcher Professor Chris del Mar of Bond University.

“And that the harms would be much less,” says del Mar.

He says clinicians and patients need to make decisions based on more accurate information on the pros and cons of such interventions.

“This is one of the most important ways we can save the healthcare system from going bust.”

Del Mar and Associate Professor Tammy Hoffmann carried out a systematic review of 35 studies analysing patient expectations of tests and treatments.

The studies covered such interventions as mammography, prostate specific antigen (PSA) tests, angioplasty, stem cell transplants, statins, kidney transplants, bariatric surgery, inflammatory bowel disease drugs and resuscitation after a cardiac arrest.

This wishful thinking must be a factor in the general mistrust of medical science. Either the facts are poorly communicated by the medical profession, and/or patients are strongly prejudiced against factual assessment — biasing their understanding toward the overly optimistic.

Such mistrust in medical science is powerfully exploited by practicioners of alternatives to medicine, whether they are “Big Placebo”, “Big Herba”, or any other industry of quacks preying on the sick and vulnerable who hope for more.

The science-based medical profession is often rightly criticised for spending so little time with each patient that they treat symptoms, not people. This in turn is also exploited by charlatans promising “holistic” treatment, but providing nothing more than would be expected from paying closer attention to overall health with any non-expert.

The Bond University researchers argue that better consultation is needed in medicine, but find that this doesn’t need to occupy significantly more time.

Del Mar says some people argue that more talk will lead to longer consultations but he says studies show this is a “myth”.

“You can do it all in the same time frame. All you’re doing is exchanging one kind of discourse with another,” he says.

“It does require a change in mindset.”

In fact, evidence suggests more talk results in less intervention, says del Mar, citing the case of PSA testing.

“If you talk to people first before you do the screening, and explain all the downstream consequences of being screened, a lot of men say they don’t want it,” he says.

While unnecessary or unwanted treatment and tests add to the cost of healthcare, del Mar says “overtreatment” can also result in physical and emotional harms.

“I think [more talking] will save money but I don’t think that’s the main driver. The main driver is delivering better care,” he says.

Here’s hoping better science will lead to better health services.

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