Misunderstanding statistics, compassion in the ED, and a quick explanation of the NNT
July 10, 2014
The RightCare Weekly is a newsletter that helps you stay on top of important news in the ongoing quest to move the U.S. health care system toward delivering the right care to all patients. We’ll bring you the most important stories, news articles, and opinion pieces of the week, along with our interpretation of why they’re important for patients, doctors, and communities.
It can be hard for patients to feel like they understand all their treatment options – but often, doctors misunderstand the options, too. A recent BBC article by William Kremer goes through the numerous issues that can arise when doctors misunderstand the statistics behind treatments and test results. Kremer highlights research showing that doctors often misinterpret or fail to account for the possibility of false positive tests and lead-time bias in interpreting the benefits of treatment or survival rates. Those misunderstandings can lead doctors to overestimate the benefits of treatment, and to encourage patients to undergo tests that won’t improve their treatment. The article covers a variety of ways to address the issue, including giving doctors better training in interpreting evidence in medical education, and on training doctors and patients to use decision-making tools that present the effects of treatment clearly and without biases that overstate possible benefits.
On a related note: The NNT is one of the most useful, relatable ways to communicate the value of a medical procedure. Aaron Carroll has a new Healthcare Triage video this week that lays out just how important it is to understand what the real benefits of a treatment are, and why it’s hard to tell if a drug that reduces the risk of a particular bad outcome by 50% is a miracle, or practically useless. The video on the Number Needed to Harm, or NNH, will be posted on the Healthcare Triage Youtube channel next week.
Leana Wen writes for KevinMD about how simple, personal actions can sometimes be more helpful to a patient than any medical intervention. When a young mother visited Dr. Wen’s ER complaining of a headache and asking for pain medication, the ER tech offered to watch the patient’s crying baby so the mother could sleep. That brief respite was critical; when the patient woke up, her headache was much better. Wen writes that doctors often are so accustomed to giving medication in response to complaints that they forget that sometimes non-medical interventions work best.
A few years after Sarah Palin and others falsely called an end-of-life planning provision in the ACA “death panels,” Harold Pollack revisits the importance of advance planning for people with serious illnesses. He brings together a variety of powerful quotes, all showing that there’s nothing to fear from frank discussions of what patients want at the end of life – and indeed, that those conversations are the only way to give people the treatment they want.
“Some are unjustifiably concerned that end-of-life planning might mean you could be steered away from high-cost care. All I know is that, without these conversations, you are 100% guaranteed to only get the care someone else chooses.” —Amy Berman, a cancer patient and a Senior Program Officer at the Hartford Foundation
New guidelines laid out by the American College of Physicians say that yearly pelvic exams are unnecessary for women who are not pregnant or experiencing any symptoms. Their decision is based on research that shows these exams may do more harm than good. The USPSTF no longer recommends annual Pap tests, which were the original justification for annual pelvic exams; meanwhile, the exams are often painful or uncomfortable, inspire substantial anxiety, and can lead to unnecessary surgery (1.5% of women screened, in one study). At this point, the exams are “more ritual than evidence-based practice.”
International Physicians for the Prevention of Nuclear War (IPPNW) was an important part of Dr. Bernard Lown’s humanitarian work. In 1985, Dr. Lown and Dr. Yevgeny Chazov were awarded the Nobel Peace Prize as the group’s founders. This week, we read a fascinating article that touches on the group’s history, inspired by a new collection of documents from Medact.