Wednesday, February 08, 2012

Why do patients make the wrong decision sometimes ?

Patients are often forced to choose between various alternatives when they are ill . They sometimes make the wrong decision. Doctor Groopman's book , Your Medical Mind , provides some very interesting insights into this phenomenon. Making a decision involves thinking, as as with any other thought process, we are exposed to the risk of four common cognitive biases when we make medical decisions.

The commonest cognitive bias is called framing. It's very easy to be influenced by the promotional literature which a pharmaceutical company provides ; and by the glowing testimonials on a medical website , when you need to make a decision for yourself . Our decision making process is commonly flawed , because of the way our brain works. This means that we're all prone to certain fallacies when making decisions ! These are the four common fallacies which he highlights. The first is called framing . When exactly the same information is presented to you , how you make a decision will be strongly influenced by the way the information is presented to you. Just like a certain picture can look particularly attractive because it is mounted in an attractive frame ( rather than because it has an intrinsic artistic merit) , advertisers and marketers can subtly influence what you decide, by presenting information in a particular format ( or frame). This can be both positive and negative - and depends upon their playing with words ; or with numbers. Websites which promote "natural treatment options" for treating fertility are masters at this art !

Thus, instead of saying 51 percent of patients responded to treatment , they will say - the majority of patients improved with treatment ! It's easy to fool patients , so they come away with the wrong impression. It's only when you're aware of this framing fallacy that you can be on your guard and look out for it.

The most important numbers you need to find out are :
1. NNT , or number needed to treat . This is the number of people who need to be treated , in order to improve .
2. NNH, or number needed to harm . This is the number of people who need to receive treatment in order to suffer side effects .

It's important to compare apples to apples - and you need to make sure that the people who are being studied are similar to you - they should be age-matched; and have a similar severity of their disease.

You must remain alert to the fact that framing numbers can result in cognitive pitfalls and biases and the best way to overcome this is to be aware of these. You may need to drill down to get to the meat of the information presented to you, so you can focus on the steak and not get carried away by the sizzle !

The second bias is called aversion loss ; and arises because most of us regret potential losses far more than we care about potential gains. You need to be aware of this fallacy when you make decisions about your health. Sometimes we are so scared about losing something ( for example, your ability to have sex, ) that we may go over the top and make a decision which helps to minimize the loss , but may not always be the most rational decision . The third cognitive bias is the fact that our decisions are often skewed by what he calls the focusing illusion . When we try to think about the future , we often focus on just one particular aspect which could be negatively affected. This becomes such a dominant feature in our decision-making , that we forget that we have enormous resilience and can adapt and have a satisfactory life ( even if we can't have sex anymore, for example) . Finally , there is the availability bias. When something is "top of mind" and easily available, this sways your decision making process. This is sometimes why listening to stories from other patients can result in making decisions which are heavily influenced by what happened to that particular patient. This is why infertile couples are more likely to do IVF treatment ( which they may have resisted for many years), when they meed a friend or a relative who has just had an IVF baby. Being aware of your biases will help you identify certain fallacies in your decision-making process so that you're more likely to make the right decision, rather than than do this in a haphazard disorganised fashion !

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