Read Seth Godin’s most recent post, The Amateur Scientist. In a way that only Seth can do he tells how our culture has turned us all into authorities. Important stuff.
I couldn’t help but think how this applies to the Internet and our health. Unrestrained access to information has got us all thinking we know more than we do. Godin wasn’t writing about the amateur physician but he might as well have been.
Missing from the black bag of the amateur physician is a tool called clinical judgment – the pivotal substrate necessary to tie together objective clinical information. Clinical judgment is the foundation of good medical decision-making. But you won’t find it on the Internet. It can’t be found in the cloud or the hive. It isn’t free and it’s tough to get.
When it comes to social health there’s remarkably little talk of clinical judgment. It’s an unwelcomed concept. It’s the fly in the jelly of those who dream of using the infosphere to independently map their medical destiny from their laptop.
Sure the cloud may offer us a map. But for anyone who’s been there, the judgment of an experienced Sherpa is priceless.
But I digress…
Check out Seth’s Blog. He’s one of the few original thinkers in a world that seems to value reverberation. I’ve been reading him for years now and his wisdom transcends so many professions. He has a lot to teach physicians … and amateur physicians
{ 7 comments… read them below or add one }
Great post. Salon author Farhad Manjoo wrote "True Enough: Learning to Live in a Post-Fact Society" back in 2005. While a majority of Manjoo's book focuses on media over-saturation in the political realm he takes a look at why we believe what we believe. His basic thesis can be applied to both the Amateur Physician and the Amateur Scientist. This book is a must-read for all of going forward in this digital world.
I am not altogether too sure that I agree but then I am not so sure how you define 'clinical judgement'. Seth distinguishes between sciences which is objective, and the amateur scientist being swayed by anecdote. But we know that much of clinical judgement is not based on science either. Decisions are not just made on the basis of RCTs, but take into account the subjective experience of the patient, their thoughts and ideas and values. In fact, much of clinical judgement may be built up over many years of recognising patterns in the many anecdotes we collect of patient experience. We know that can lead us to make poor judgements so increasingly we struggle to make our treatments fit with guidelines, but we still bend and flex with our patients.
Now, is that science?
I love what you are saying, but also agree with Anne Marie here. All the data in the world does not help us without the clinical judgement to use the data effectively, but at the same time clinical judgement is just years of less organized data put together into some amorphous force in our doctoring years.
Perhaps the difference is in the very nature of how we store information. Objective data is easy to put on paper, and load into spreadsheets. But the thousands of little anecdotes that we collect over our clinical careers is hard to quantify in this way… until you bring in the human brain. We have an ability to synthesize all of this data into a remarkable level of coherence that a computer and statistics seem to lack. This is why certain areas of medicine demand hands on learning rather than reading to become proficient. Almost everything I know about surgery came from operating with surgeons better than I, not from reading books. I might get ideas from reading books, but until I can put it into practice it isn't really knowledge.
There's a place judgement and there's a place for data. Both are necessary but neither is sufficient. I can look at any well reputed journal and find you several studies that are so poorly designed that their results are absolutely meaningless. It takes judgement to know that. You have to know what data is real and what is nonsense, and when good data still doesn't apply to your patient.
At the same time, sometimes experience can lead us down the wrong track…. "Experience is what allows us to make the same mistakes with greater confidence".
As a psychologist, I'd have to weigh in that the clinical judgment you gain depends greatly on the environment in which you gain it. Dr. Fogelson, you mentioned on your blog previously that your experiences in other countries made you question the clinical guidelines and practices you were taught in the US. It seems obvious that doctors in different environments would come up with different types of clinical judgment.
Incidentally, one of the arguments usually brought up against direct entry midwifery is that these women "just" shadow other midwives to learn (which is not true as stated; there is academic learning involved as well). But isn't that model the same as the one used to train doctors? Years of book learning followed by years of clinical supervision?
Clinical judgement is acquired through experience. That's why it's call the "practice" of medicine. Using the internet, you can now find more information that your physician has in her working memory. But how to prioritize and integrate all of this data still requires clinical judgement. Our site http://www.ResoundingHealth.com was built, in part, to support joint patient-provider review (aka "participatory medicine") of online information in support of personalized medicine and customized care.
Great comments. And yes, AM, clinical judgment is subjective and actually doesn't fit in exactly with Seth's argument. Thanks for calling me out. Nicholas, your comment is wonderfully written and I would encourage you to modify it as a blog post. There's some critical information there that shouldn't live within the constraints of a comment.
Excellent post. Our business focuses on communicating with those amateur physicians–the moms who spend hours online diagnosing their family's health conditions. It's an interesting quandary. So much information, so little knowledge.