The trouble with medical experts

In early February, I was on my family medicine rotation. This was around Chinese New Year, when many East Asians travel extensively. The hospital I worked in serves a large Chinese community, and rumors about a new pneumonia emerging out of Wuhan, China were spurring patients to seek our reassurance that they didn’t have it. One patient thought their stuffy nose might be ominous, while another was worried about a new rash. We told them they were probably fine. Even if they did have it, we believed a missed diagnosis would be of little consequence, since much of what we had read described COVID-19 as a variation of the flu.

But the science was (and is) still evolving. It wasn’t long before reports confirmed that stuffy noses and rashes are symptoms of COVID-19, that the virus is far more easily transmittable than we’d thought, and that it can cause suffering and death far more frequently than the flu.

In other words, in early February, despite practicing sound medicine, we were wrong.

That’s the trouble with experts: we’re only as good as the science of the moment. In fact, we’re only as good as the most up-to-date science we’ve studied. Many people are surprised to discover that their doctor is in a constant state of continued education, reading just as many tedious medical journal articles as they did when they were medical students.

The ever-moving target of “medical fact” is just one of the barriers stymying those who communicate science and those who need to hear it. So bear these things in mind when you listen to experts:

Scientists tend to simplify complex things—and sometimes oversimplify them. Early on, experts advocated sheltering in place to “flatten the curve” and prevent a surge of cases that would overwhelm hospitals. Mission accomplished! But there was more they didn’t say: continued social distancing would almost certainly be needed, because outbreaks can still occur after the curve is flattened—as is happening in South Korea and Germany, among many other countries. Likewise, consider experts who initially compared COVID-19 to the flu. We thought this would help the public understand how the disease works. The limits of the comparison were quickly obvious. Simplifying or generalizing scientific findings helps experts transform complex ideas into actionable advice. The price? Undercutting public trust in expertise when the situation changes, or laying the groundwork for misleading political debates in which oversimplified ideas are pitched as absolute fact. It’s a tough balance to strike, and reasonable people can disagree over the best messaging choice.

Expert advice is probabilistic. If you draw one card from a deck, we can only guess what it will be. But if you draw 11 cards, we can almost guarantee that one will be an ace. “Lots of people will get COVID-19” doesn’t mean most people will. And if you and your friends don’t get it, it doesn’t mean the prediction was wrong. Scientists, especially epidemiologists, speak in terms of data and trends, while the rest of us think in terms of subjective experience. With few exceptions, scientists tell us what is likely within a group, not what is certain to befall you in particular.

Experts talking outside their field probably don’t know much. Some talking-head doctors on TV are brilliant. Others are professional commentators who happened to have attended medical school. Consider who’s talking: when a so-called expert puts forth something beyond their credentials, he or she is probably not worth your attention. You don’t ask your plumber about electrical wiring. Don’t quiz your cardiologist about the global pandemic.

Start off every engagement by assuming goodwill. As someone who now analyzes COVID-19 research on a daily basis, I deal with data, but trust is ultimately a personal decision. Regardless of their politics or background, I can’t name a single scientist studying COVID-19 who hasn’t put that aside to get us out of this quickly and with a minimum of suffering and loss of life. They’re not trying to deceive anybody. But they sometimes assume you know they’re speaking in hypotheses instead of facts. As a result, when their best-guess predictions fall through, you might be tempted to assume ill-intent.

As scientists, we have work to do too. We need to get better at communicating with the public, the vast majority of whom have no knowledge of epidemiology, infectious diseases, or the uncertainty of science. We need to acknowledge that public health expertise is not the only factor that informs public policy and that we are aware of how culture, commerce, and human nature must be factored in, too. Lastly, we need to be more available to counteract the misleading information from the non-experts.

We need better communication about science—and better listening. It begins with reminding ourselves of the limits of knowledge, our own, and each other’s.

Henry Bair is a medical student.

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