186 Being a Doctor After Being a Patient
The Advantages of Medical Knowledge: Knowing What the Statistics Mean
Routinely, in confronting their own disease, these doctors drew on their medical training and found that possession of medical knowledge provided distinct benefits. Many cited how they had‘‘ learned from clinical experience,’’ and used this background in evaluating research and interpreting statistics concerning prognoses and side effects. Generally, they thought they‘‘ knew what the statistics meant’’( how to interpret them). Compared with many other patients, they felt they understood relative risks.
Many believed they were less wary than their patients of medications and statistically improbable side effects. These doctors saw lay patients as frequently getting hung up on risks of complications, fearing that unlikely complications might nonetheless occur. Such patients may be overly responsive to negative possible outcomes, even if these are improbable.
In processing information, many of these doctors thought that patients often felt that a percentage likelihood of a complication happening meant that it would occur— that patients did not understand how to interpret and weigh the relative risks of disease progression. Walter, with lymphoma, said:
Patients don’ t understand statistics— if you get a complication, you get it 100 percent; if you don’ t get it, you don’ t get it at all. When we start patients on a new medication, we give them lists of all the complications. It’ s very important to explain that it doesn’ t mean that they will get it, but that there is a chance. It’ s amazing how many times I have to go over it— which means that most doctors don’ t discuss it. Patients are much more aware of side effects than of the fact that they have a fatal disease that, untreated, will be fatal.
In patients’ minds, detailed and explicitly presented side effects loom large.
As a result of their clinical training and experience, these doctors have experience in calculating and weighing relative risks against relative benefits, developing‘‘ gut feelings’’ and intuitions. In comparison, they thought that media attention and hype about findings of particular studies influenced lay patients’ risk perceptions more heavily. Harry, the internist and war refugee, added: