The ‘July Effect’ Revisited: Why the Most Experienced Doctors Don’t Always Deliver the Best Medical Care |

A good piece on the ‘July Effect’, so-called for the arrival of new doctors in teaching hospitals and their lack of experience. The article notes that doctors are only human and suffer from the same biases as we all do:

Anchoring bias, which causes doctors to lock onto a diagnosis early and disregard new and conflicting information. For example, a patient may be diagnosed with a quickly fatal cancer, but then ends up trying various (ineffective) herbal remedies and lives for 30 more years. Instead of considering whether the initial diagnosis was incorrect, the patient — and maybe even the doctor — may falsely assume that the herbal remedies cured the cancer.

Availability bias, when clinicians tend to think that the patient they are treating today has the same condition as the patient they treated last week. Imagine your doctor saw a rare, life-threatening illness last week that presented with a common symptom, such as belly pain. Today, you’re in the doctor’s office for belly pain, and your doctor may be unjustifiably concerned that you too have that rare life-threatening disease just because she’s still thinking about it.

Confirmation bias, which causes doctors to believe evidence when it supports their pre-conceived opinion, while ignoring evidence that contradicts it. For example, let’s say your doctor is pretty certain that you have an infection, and orders a test to confirm the suspicion. The test is negative for infection, but she treats you for it anyway because she doesn’t believe the test results; meanwhile, she disregards clues that point to another, correct diagnosis.

Commission bias, when doctors err on the side of doing something — like ordering a prostate biopsy — as opposed to watchful waiting because it seems that doing something is better than a doing nothing.

Usefully, the article notes that for procedures requiring a high degree of technical skill (e.g., open-heart surgery, obstetrics, trauma care), practice indeed makes ‘perfect’, but in other situations, medical evidence trumps experience (e.g., cancer diagnosis and care, managing chronic conditions). Quote:

So what can you do as a patient to receive the best care? Well, maybe nothing if you get admitted on an emergent basis to a teaching hospital during July. But one thing you should always do is ask a lot of questions. It may not always be possible to determine that your doctor has fallen victim to an unconscious thinking trap or that she’s practicing outdated medicine. But asking questions does force your doctor to think and justify decisions about your care.

Secondly, become an informed patient: try to learn as much as you can about your medical issues and what trusted sources recommend as the “right” approach. Even 15 years ago, it was rare for a patient to crack open a medical textbook to question a treatment decision. Now, online resources such asMedlinePlus, provide both up-to-date and easy-to-understand explanations of complex medical care. A good summary of evidence-based medicine can also be found at the Agency for Healthcare Research and Quality’s website.

The ‘July Effect’ Revisited: Why the Most Experienced Doctors Don’t Always Deliver the Best Medical Care | Healthland |


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