An expert in risk and decision-making believes patients need to participate more in their own treatment in a bid to reduce error, writes Claire O'Connell
MEDICINE DOESN'T always have the right answers, healthcare professionals are not infallible and patients need to participate more in their own health and treatment. That's according to an international expert in risk and decision-making who will speak at a conference in Dublin City University this week.
"Everywhere in the world when it comes to healthcare there's a belief in the 'gold standard', some absolutely correct answer," says Prof James Shanteau, professor of psychology at Kansas State University, who has analysed decision-making in fields as diverse as agriculture, air-traffic control and healthcare.
"But all the evidence that we have from medicine and other areas I worked in show that any standards that have ever been set change, they evolve over time," he says.
"It's partly because as a gold standard is used, people realise the limitations, where it doesn't work, and they have to expand and modify the definitions. Also, new equipment and technology, science changes things and that's the way science works."
But in medicine, we tend to believe the current gold standard will solve everything, explains Shanteau.
"What I find in my studies is a very strong desire for people to believe that at this point in time and in this place there is an absolutely correct answer and I think that causes a lot of problems," he says.
And we still expect healthcare professionals to solve the problems even though they may have fewer data to hand than in other walks of life, where we forgive unfavourable outcomes more easily, notes Shanteau.
"People have done a great deal of research with weather forecasters and they have a gigantic advantage in two respects: one is they have a marvellous technology based on satellite information from all over the world and they have gigantic computers to put it all together.
"Secondly, they can look back in time and see what happened the last time they made a forecast like this," he says.
"And even with all that advantage, weather forecasters still make mistakes and we know they can't be perfect.
"The irony is we are perfectly willing to forgive a weather forecaster and very unwilling to forgive the mistake of a healthcare professional. And they don't have the same advantages that exist in the area of weather forecasting."
So how do mistakes happen in healthcare? It could be down to human error, overworked and under-resourced staff, or even a patient stopping medication prematurely because they feel better.
To help identify ways of solving the problem, computer programs have been developed to aid accurate diagnosis and prescription.
But while the software can help in training healthcare professionals, things can get more complicated in practice, and Shanteau argues the computer algorithm can't replace the art of human interaction in medical diagnosis.
"The [computers] are missing the patient context and the doctor context and the patient-doctor interaction context.
"What they are looking at is simply a medical physiology problem, what are the signs, symptoms and prescribed treatments," he says.
"What I have been arguing for, for several years, is that these computer programs should not be designed to deliver answers, they should help doctors by pointing them to better questions.
"You don't want a computer program telling the doctor to treat the patient this way.
"That is always the doctor's decision. But they could remind the doctor to ask what the family history was, or if this patient had a childhood disease that could be influencing him now."
He also sees it as key that patients engage more in the process of diagnosis and treatment, build up a rapport with the healthcare professional where possible and seek out information.
"At least come in being hopefully an informed consumer rather than saying 'I have no idea what is wrong with me, tell me what kind of medication I should take'," he says.
And he notes the importance of patients following through on prescribed treatments such as antibiotics and generally keeping themselves in good nick.
"Doctors are always telling patients to eat better, exercise more, get regular sleeping hours, avoid stress and anxiety. How many patients do that?
"We know what's good for us but we can't bring ourselves to do it," he says.
"These are lifestyle choices which have consequences for your health. And we know that people with a healthy lifestyle tend to have fewer problems with their health."
We also need to bear in mind that sometimes even the "right'' answer will still have an unfavourable outcome.
"You can do all the right things and still things can turn out wrong.
"It's like driving a car, you are within the speed limit and everything is fine. Then someone comes along from the side who isn't looking and you have an accident. It wasn't your fault. Things happen," he says.
"There are things that can go wrong that nobody understands.
"You made all the best decisions, taking into account all the risks and the possibilities but there are simply no guarantees that it is going to turn out right."
• Prof Shanteau will speak this Thursday at 9.30am at the Health4Life conference in Dublin City University's School of Nursing. The conference, Judgment, Assessment Decision Making in Health Social Care, which is open to all health and social care professionals, runs on Wednesday and Thursday and will also feature talks about care of the older person, service-user perspectives, recognising child abuse and issues in maternity care and midwifery.
The conference fee is €100, but the public can attend Prof Shanteau's talk and other workshops for €50. Contact DCU at 01-700 8517 for more details