Physicians should be involved in health care decisions

As physicians progress through medical training and acquire new knowledge and skills, something interesting happens. They also develop a new and increasing awareness of not only how much they didn’t previously know but also how much they still don’t know. This process sounds paradoxical but has been consistent with my personal experience: The more I learn, the less I think I know.

Any seasoned clinician knows that in order for one to safely practice medicine, appreciating what one does not know is equally important to the knowledge base one has.

It’s interesting to note that this phenomenon has a name: The Dunning-Kruger Effect. Dunning and Kruger performed a series of experiments to prove their hypothesis (Wikipedia):

1. Incompetent individuals tend to overestimate their own level of skill.
2. Incompetent individuals fail to recognize genuine skill in others.
3. Incompetent individuals fail to recognize the extremity of their inadequacy.
4. If they can be trained to substantially improve their own skill level, these individuals can recognize and acknowledge their own previous lack of skill.

So, people are not aware of what they don’t know, have difficulty appreciating expertise that others have acquired, but with enough training eventually can recognize that they previously overestimated their knowledge.

I learned about this myself because back in my college days, I was an emergency medical technician (EMT) for an ambulance service and emergency room. I realized when left my EMT work and progressed through medical school and residency how much I had previously overestimated my own medical knowledge.

Interesting. But why does the Dunning-Kruger effect matter?

I believe that it validates concerns that many physicians have today about those who have little or no medical training instituting changes in how medicine is practiced without involving doctors in the process.

The issue is more relevant today than ever with so many competing interests trying to get a slice of the health care “pie.” And, to be fair there are many very bright non-physicians who are experts in their own fields. They know more about their own areas than do most physicians. Since the Dunning-Kruger effect is not exclusive to physicians, I am certain that many of them have also experienced the effect during their own educations and training.

Many of these non-physician experts may know a great deal about business, management, financial, legal, or systems issues. They may be data experts.

But, there’s so much about practicing medicine that can never be quantified. Doctors don’t make widgets; we take care of people’s lives.”The art” of practicing medicine is not something that many such experts want to discuss.

In the words of Albert Einstein:

Not everything that counts can be measured. Not everything that can be measured counts.

But regardless of whether the issue involves the art, science, or business of medicine, there are countless examples of where physician input could have produced a better outcome.

One is the use of patient satisfaction scores to determine physician pay, which as Dr. Kevin Pho explains, provides doctors an incentive for ordering unnecessary medications and diagnostic exams. Yes, it’s important to satisfy patients to a point, but giving them whatever they want is not good medical practice.

Another is the complaint that Dr. Edwin Leap describes about electronic medical records being great at collecting data but unfortunately also at least as good at hindering instead of helping work-flow and efficiency.

When it comes to improving the practice of medicine, doctors do not have all of the answers. We need input and data from non-physician experts. But all too often I believe that many others assume that they know best, and that it is inconvenient or unnecessary to involve doctors in the process of improving health care.

The challenge is that some people will never know what they don’t know and will therefore continue to undervalue physician input.

Jeffrey Knuppel is a psychiatrist who blogs at Lockup Doc.

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