Do you suffer from decision fatigue when you are sick or anxious or overwhelmed by bad health news? Does your doctor make less well-reasoned decisions about the 10th patient she sees before lunch? How about the surgeon during his second operation of the day? How about the radiologist reading the last mammogram in a daily batch of 60?
A provocative article by John Tierney in Sunday’s NYTimes Magazine adds a new layer of complexity to the body of knowledge collecting around decision-making processes. Considerable news reporting has focused on how cognitive biases influence our judgment and how many of us experience the abundance of choices available to us as a burden rather than a privilege. This article adds to that understanding: Our decision-making abilities appear to be powerfully affected by the demands of repeated decision making as they interact with depleted blood glucose levels. That fatigue mounts over a day of making decisions and as blood glucose levels fall between meals. In response, we tend to either make increasingly impulsive decisions without considering the consequences or to make no decisions at all. Tierney describes a study analyzing 1,100 parole decisions by judges over the course of a year: “Prisoners who appeared early in the morning received parole about 70 percent of the time, while those who appeared late in the day were paroled less than 10 percent of the time.”
“Most physicians are competent and able to take care of most of the problems patients present with. The standards for getting into medical school are high and for getting out are higher. I think this call for patients to become experts in picking their doctors is overstated.” – David Rovner, MD, Professor Emeritus, Michigan State University
Most? What does “most” mean? Can most doctors treat me for the flu? How about pancreatic cancer? Must I conduct the same type of research to choose a doctor to set my broken arm that I do to find one to treat my mom’s congestive heart failure? Is the same level and type of research necessary to find a good surgeon as for a primary care clinician? Read more »
A recent piece in the LA Times created quite a kerfuffle in the social health infosphere. The article When Facebook goes to the hospital, patients may sufferdetailed some of the issues facing hospitals that have chosen to flirt with Facebook. Stories of nurses posting images of dead patients. Lawsuits and employee rights. An interesting read. It offered up a serving of fresh red meat for those health professionals looking to keep their heads squarely in the sand.
A few thoughts:
Blocking Facebook won’t stop stupidity. Read Paul Levy’s most recent post on the issue. He reminds us that administrative legislation will not stop ignorance. It’s the messenger, not the medium. As healthcare administration’s most vocal advocate for social adoption, I’d recommend you check out Paul Levy. His point of view is remarkable.
Good employees may not understand privacy. We need to go to the next step and address the fact that many hospitals have employees who don’t understand the privacy laws. We still have a responsibility to protect patients from the misinformed. While it’s suggested that you “can’t stop the conversation,” it’s important that hospitals take responsibility and educate their employees regarding what’s appropriate and what isn’t. Many health professionals I know innocently believe that by simply excluding an individuals name you’ve protected their privacy. We have work to do. Read more »
*This blog post was originally published at 33 Charts*
Now three of his friends have written essays about this important issue:
We who’ve worked on it hope it will provoke thought about how healthcare is changing because of what e-patients can contribute, empowered as individuals and enabled by the Internet. To start that process, we’re publishing the introduction.
Three friends and mentors generously offered introductory essays. These essays they have little to do with my story, and everything to do with howe-patients can help heal healthcare:
Hospitals are using twitter and billboards to broadcast emergency department waiting room times. This is not without risk, as billboards may not clarify the triage process, where seriously-ill patients will be seen right away.
Recent articles from NEJM and JAMA articles on medical students and social media.
A lot of the developments in openness in peer review and the world of grant funding are chronicled at Nature’s Peer-to-Peer blog. Bora Zivkovic has been and active an articulate defender of open publications as well.
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