Spark [Robert_Klitzman]_When_Doctors_Become_Patients(Boo | Seite 204

Double Lens 193
The physicians drew on their research skills, critically reading and noting
limitations of any one study, the complex variables involved. Jim con-
tinued:
Being a researcher helped me as a patient—knowing that treat-
ments and experiments don’t always work. A simple thing—a tiny
hidden variable—can confound a very complex molecular biol-
ogy experiment.
Particular skills and experiences as a physician could prove especially
valuable.
At the extreme, some felt that, in fact, ‘‘the literature lies.’’ Jacob
thought so, since, he felt, only confirmatory findings got published.
Consequently, he challenged the reliability of the literature as a basis for
making decisions. Yet his attitude may also reflect rationalization—part
of his decision to avoid reading the literature concerning his diagnosis.
Many felt disappointed by the limited generalizability of much of medical
research. For example, in estimating prognoses, medical literature spoke
of group means, but not individual patients. Juan, a clinician, felt frus-
trated that prognoses were based on medians not specific to him.
They’ve got all these statistical estimates of survival, but they’re
just estimates. I’ve said to patients, ‘‘I can tell you what percent of
people are alive so many months or years after their first pneu-
monia. But I cannot give you the information for you.’’
He saw researchers as ‘‘they’’—separate and distant.
Criticism arose, too, of how, increasingly with the growth of medical
research, trainees learned from computerized literature searches rather
than from patients. Physicians also often consulted medical literature
only superficially, performing literature searches, but reading merely the
abstracts, not the articles themselves. Sally, the internist with cancer who
brought her laptop to the ICU, said about her own traditional medica