As someone who works in medicine, I'm really torn on this article. The author makes a lot of really good points but unfortunately this is clouded by their own strong opinion. The central thesis of...
Exemplary
As someone who works in medicine, I'm really torn on this article. The author makes a lot of really good points but unfortunately this is clouded by their own strong opinion. The central thesis of the article is definitely one that I resonate with and a narrative that have heard often repeated in medicine - more information is not always more helpful, especially when individuals do not understand how to parse said information. The anecdotal experiences of individuals struggling to quell their anxiety or seek answers by reaching out to their medical professionals before said professionals even had a chance to review the information that the patient is looking at is definitely a narrative worth unpacking. I've seen a variety of methods to address this issue, one of which is to simply not release lab results until the doctor has reviewed them. Most institutions seem to have settled on this as a good compromise between speed and expert opinion. This gives the clinician the ability to contribute their own narrative or opinion on the results before the patient even sees it. The clinician is able to head off concerns or give context for abnormal values or findings that may not be of concern when combined with other objective measurements or ruled out diagnoses.
What's missing from this narrative, unfortunately, is what this clinician is never exposed to. There is no insight into the number of individuals who are anxious until they are able to see their results - the individuals whose anxiety is based in the uncertainty. This also leaves out individuals who are able to interpret their own results or who have some kind of training or education to understand the lab values or notes that are presented to them. There is an unfortunate selection bias present here that the clinician is only exposed to the individuals who are the most anxious. There's also no way to know that these patients wouldn't already be calling even without the lab results and leaving messages for their provider having gone to textbooks, the internet, or friends and discussed their problem.
I find it curious that the author spends so much time talking about the potential negatives of transparency that they don't spend a whole lot of time talking about the positives. There's no mention of the effect of transparency on accountability and how transparent institutions are not only more accountable to the people that they serve, but they often end up with better ethics. The author talks about informative and uninformative versions of transparency and posits said there must be a specific level of transparency in order to breed the best results. This does not play out in literature and quite the way that the author believes. Studies around transparency and information or informative versus uninformative transparency show that informatively transparent institutions are much more effective than uninformative ones. Uninformative transparency is associated with failed organizations, often found in corrupt organizations and governments. The author also posits that they need to be censoring themselves when presenting information to patients. With no feedback from these patients themselves, it is purely the authors untested hypothesis yet they fail to examine this. They believe they must self censor and provide uninformatively transparent information as a response to some of the negative feedback they've received without objectively examining whether this is an effective solution - they are understandably trying to protect themselves and their time and to ensure that anxious patients are treated compassionately, but they fail to ask these patients what would help them best.
Perhaps ironically, the article ends with an anecdote where they center the patients experience and needs. The anecdote seemingly is supposed to support the idea that patients don't need more information to be treated compassionately. This is the first time that the author asks the other party involved what they want and need. The reason it's so effective is that the patient is allowed a voice in the level of transparency that's most helpful to them. Healthcare is an exceedingly collaborative environment - an environment which often involves a care team of nurses, doctors, front line staff, administrators, technicians, specialists and more. What many healthcare professionals often lose sight of is that healthcare is collaborative with the patient as well. Understanding what the patient wants and needs is essential to providing them quality care. A patient at the end of their life is often given this grace, but historically this has not always been true. Concepts such as a do not resuscitate order (DNR) which specific when a person wants to be allowed to pass away, the quality of life associated with various potential treatments and outcomes (quality adjusted life years or QALYs), informed consent, and other patient centric discussions of potential care are all fairly new concepts and took a lot of advocacy before they caught on. In fact, many of these patient centric approaches are still regularly debated and are not standard regimen in many specialties of medicine. This patient centric approach, however, results in significantly happier patients and physicians and unsurprisingly objectively better outcomes. The answer is not to censor oneself out of concern for the patient, but rather to have a discussion with each patient about the level of communication they desire. The clinician is there to help the patient navigate the system, collaboratively, and not allowing the patient to participate in these discussions is paternalistic and damaging to the systems credibility. Self censorship is not the answer. Transparency is not problematic when everyone is given a seat at the table. Unfortunately the author seems to be unaware that they are depriving the patient of their voice and are presenting solutions from their one-sided perspective.
As someone who works in medicine, I'm really torn on this article. The author makes a lot of really good points but unfortunately this is clouded by their own strong opinion. The central thesis of the article is definitely one that I resonate with and a narrative that have heard often repeated in medicine - more information is not always more helpful, especially when individuals do not understand how to parse said information. The anecdotal experiences of individuals struggling to quell their anxiety or seek answers by reaching out to their medical professionals before said professionals even had a chance to review the information that the patient is looking at is definitely a narrative worth unpacking. I've seen a variety of methods to address this issue, one of which is to simply not release lab results until the doctor has reviewed them. Most institutions seem to have settled on this as a good compromise between speed and expert opinion. This gives the clinician the ability to contribute their own narrative or opinion on the results before the patient even sees it. The clinician is able to head off concerns or give context for abnormal values or findings that may not be of concern when combined with other objective measurements or ruled out diagnoses.
What's missing from this narrative, unfortunately, is what this clinician is never exposed to. There is no insight into the number of individuals who are anxious until they are able to see their results - the individuals whose anxiety is based in the uncertainty. This also leaves out individuals who are able to interpret their own results or who have some kind of training or education to understand the lab values or notes that are presented to them. There is an unfortunate selection bias present here that the clinician is only exposed to the individuals who are the most anxious. There's also no way to know that these patients wouldn't already be calling even without the lab results and leaving messages for their provider having gone to textbooks, the internet, or friends and discussed their problem.
I find it curious that the author spends so much time talking about the potential negatives of transparency that they don't spend a whole lot of time talking about the positives. There's no mention of the effect of transparency on accountability and how transparent institutions are not only more accountable to the people that they serve, but they often end up with better ethics. The author talks about informative and uninformative versions of transparency and posits said there must be a specific level of transparency in order to breed the best results. This does not play out in literature and quite the way that the author believes. Studies around transparency and information or informative versus uninformative transparency show that informatively transparent institutions are much more effective than uninformative ones. Uninformative transparency is associated with failed organizations, often found in corrupt organizations and governments. The author also posits that they need to be censoring themselves when presenting information to patients. With no feedback from these patients themselves, it is purely the authors untested hypothesis yet they fail to examine this. They believe they must self censor and provide uninformatively transparent information as a response to some of the negative feedback they've received without objectively examining whether this is an effective solution - they are understandably trying to protect themselves and their time and to ensure that anxious patients are treated compassionately, but they fail to ask these patients what would help them best.
Perhaps ironically, the article ends with an anecdote where they center the patients experience and needs. The anecdote seemingly is supposed to support the idea that patients don't need more information to be treated compassionately. This is the first time that the author asks the other party involved what they want and need. The reason it's so effective is that the patient is allowed a voice in the level of transparency that's most helpful to them. Healthcare is an exceedingly collaborative environment - an environment which often involves a care team of nurses, doctors, front line staff, administrators, technicians, specialists and more. What many healthcare professionals often lose sight of is that healthcare is collaborative with the patient as well. Understanding what the patient wants and needs is essential to providing them quality care. A patient at the end of their life is often given this grace, but historically this has not always been true. Concepts such as a do not resuscitate order (DNR) which specific when a person wants to be allowed to pass away, the quality of life associated with various potential treatments and outcomes (quality adjusted life years or QALYs), informed consent, and other patient centric discussions of potential care are all fairly new concepts and took a lot of advocacy before they caught on. In fact, many of these patient centric approaches are still regularly debated and are not standard regimen in many specialties of medicine. This patient centric approach, however, results in significantly happier patients and physicians and unsurprisingly objectively better outcomes. The answer is not to censor oneself out of concern for the patient, but rather to have a discussion with each patient about the level of communication they desire. The clinician is there to help the patient navigate the system, collaboratively, and not allowing the patient to participate in these discussions is paternalistic and damaging to the systems credibility. Self censorship is not the answer. Transparency is not problematic when everyone is given a seat at the table. Unfortunately the author seems to be unaware that they are depriving the patient of their voice and are presenting solutions from their one-sided perspective.
https://archive.is/tHYrI