Monday, October 08, 2012

Complexifiers and simplifiers - clinical practise and research

In general, most doctors fall into two categories . There is one group  which tends to make everything extremely complicated. They use a lot of technical jargon , and often will end up mystifying both the disease process as well as the treatment options. In contrast , the second group of doctors are the simplifiers , who get to the heart of the matter by focusing on broad principles and stripping away all the arcane details.

It's not just doctors who behave in this fashion. A lot of experts do this as well . Koestler divided professionals into two groups - the lumpers , and the splitters . The lumpers were the simplifiers, who would try to find common patterns and broad themes to unify what seemed to be different items; while the splitters were the ones who would dig deep down in the details, to try to identify differences.

Both these are complementary approaches and need to be applied with care. In a research setting, using a splitter’s approach is helpful because you need to differentiate and try to find out what separates one patient from another. On the other hand when providing clinical care. I think simplification is far more important because otherwise patients get very confused.

So, why do doctors in clinical practice still enjoy making matters complicated ?
I think there are four reasons for this.

One is that often they are themselves so confused , that they don't have clarity as to the basic principles of either pathophysiology or treatment. When you are confused. It's easier to cover your cluelessness by using a lot of technical jargon , so that the person you're talking to has no clue that you don't understand what's happening. This is particularly true of IVF specialists when they discuss the technical minutiae of fields such as genetics and immunology. These are often areas which they understand nothing about. Consequently, they will often mindlessly overtest patients for problems in these areas. Because they don't have a clear grounding of basic principles in this field, they blindly follow the advice of so-called technical experts in these areas ( who have a vested interest in making sure doctors use their services and order lots of tests in their area of specialization, irrespective of whether these tests actually help the patient to get pregnant or not !) These technical experts are research scientists who do not have a very sound clinical base. This often means that the left hand doesn't know what the right hand is doing, and this ends up wasting a lot of the patient’s time and money and energy .

The other reason a lot of doctors will complexify  matters is to put patients in their place. A lot of doctors are threatened by patients who are well informed , and one way of establishing their superior professional status is by using complex technical terms  which patients don't understand. This helps them to establish their professional superiority and assert their authority. When the doctor starts spewing all these complicated terms , the patient gets lost and is forced to beat a retreat.  This a very effective tool for putting patients in their place and making sure that patients will follow the doctor’s orders unquestioningly.
Some doctors complicate matters purely because they are not capable of being able to talk in simple layperson's terms. A lifetime of studying medical jargon and talking only with other specialists using medical technical terms often means that they are just not able to express their thoughts in clear, plain language. However, rather than acknowledge their inability do so, they will mask their incompetence by using complex terms.

Finally,  using complex technical jargon is a useful tool to impress patients. Naïve patients are dazzled by the breadth and depth of their doctor’s professional knowledge ! Using complex terms allows the doctor to assert his authority as an undisputed expert; and this helps him to inspire confidence among his patients !  Doctors are supposed to be omniscient, and using complex terms helps to reinforce this
belief !

The rule is simple – if you do not understand what your doctor is saying, this does not mean that you are dumb – it just means that he is not smart enough to explain in  terms which you can understand ! A good doctor , like a good teacher, takes a top-down approach when talking to his patients. He will start from where his patients are - he acknowledges that his patients may not have much knowledge about their specific problem . He then provides progressively more information to his patient , so that the patient can make sense of what is happening to them. The purpose of the explanation is not to dazzle the patient with his superior medical knowledge , but to help the patient understand what is happening to him !

A good doctor will also create lots of tools; and use many different approaches when educating his patients, because he understands that every patient is different; and everyone has different learning styles !

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