Doctors and Patients

9/4/2005 4:45:25 PM

Doctors and Patients

An instructor in my business program, who happens to be a lawyer, remarked about why lawyers with engineering and science backgrounds were highly sought after and paid handsomely compared to their peers with liberal arts degrees.

The problem with using lawyers as advisors is that, while they know the law, they do not understand the business. Lawyers are versed in the various areas of law—contract law, crimimal law…; know the underlying legal theories—agency theory, partnership theory, …; have been through the legal process several times; and keep up-to-date with court rulings as well as the latest changes in local, state and federal law. Generally, lawyers are excessively conversative, because all they see are the legal risks.

In contrast, the business executive—the advisee—understands his business very well, but doesn’t understand the law. The executive can see the opportunities, but not the legal exposure. If he had both information, he would better be able to weigh the opportunities against the risk.

The ideal person is a mixture of the two, who understands both the business opportunities and the legal risks. Thus, a lawyer with an engineering degree is usually better able to absorb technical aspects of the technology business more quickly than one with a liberal arts degree.

A similar problem occurs in medicine: A doctor spends years studying medicine and the general aspects of the human body. However, the patient has a better understanding of his own body, its history and its own unique characteristics. He also has first-hand experience with the illness.

In cases where the patient is suffering from unique problems, the doctor may not be able to diagnose the problem and will often instead prescribe a placebo or label the patient a hypochrondiac until sometime the problem becomes serious and more apparent such as the teenager, who makes repeatedly goes to doctor and dismissed as a hypochrondiac, but only years later is diagnosed as a Type-1 diabetic, or the smoking mom, who, after repeated trips, is only diagnosed with lung cancer after half her body becomes paralyzed. Many times, the illness doesn’t grow in severity; it may just be a chronic annoyance and remains difficult to diagnose.

There’s also a broken feedback loop. The doctor may think he has cured the patient, when the patient doesn’t return, yet the patient doesn’t return because the doctor hasn’t proven helpful and may even be rude and dismissive and the patient also doesn’t want to incur a substantial fee for each visit. The doctor is rarely contradicted, so his poor practices may actually be reinforced.

Chris Weed pointed me to this interesting article about special communities based on medical mutual- and self-support by laypeople.

Working with several colleagues, I initiated an observational study to analyze the ways in which E-patients were using this new medium. Since I am an epilepsy specialist, we decided to focus on an epilepsy support group at the site Lester had created, BrainTalk Communities (http://www.braintalk.org) (Figure 1) [8]. The BrainTalk Communities currently host more than 300 free online groups for neurological conditions (such as Alzheimer disease, multiple sclerosis, Parkinson disease, chronic pain, epilepsy, and Huntington disease) for patients across the globe. More than 200,000 individuals visit the BrainTalk Communities' Web site on a regular basis. This site is now owned and operated by an independent nonprofit group, BrainTalk Communities, and is no longer formally associated with Massachusetts General Hospital.

What we found surprised us. We assumed that most interactions would be support related, with some members describing their medical experiences and others offering active listening, sympathy, and understanding. But while such interactions were an important part of the group process, they were observed in only about 30% of the postings. In the remaining 70% of the postings, group members provided each other with what amounted to a crash course in their shared disease, discussing topics such as the anatomy, physiology, and natural history of the disorder; treatment options and management guidelines for each form of treatment; and treatment side effects, medical self-management, the day-to-day practicalities of living with the disease, and the effects of their condition on family and friends (Table 1).

What is happening here is that these members are talking to others experiencing related ailments. The group’s collective knowledge compensates somewhat for the gaps in knowledge of any individual person.

UPDATE: Chris also points me to the articles, “Paradox of Expertise” and “Integrating Methodologists into Teams of Substantive Experts,” both of which deal with how the narrow specialization of experts backfires on them, when making conclusions outside their domain.

 

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Net Undocumented is a blog about the internals of .NET including Xamarin implementations. Other topics include managed and web languages (C#, C++, Javascript), computer science theory, software engineering and software entrepreneurship.

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