Or what I referred to last post as “the flavors of Goldilocks.”
Too much data and your eyes glaze over, and too little prevents you from making an informed decision.
I fear that I tend towards giving you too much, and I’m sorry if you’ve had to skim because the material didn’t seem to apply to you (or if my Star Trek references left you scratching your head).
But the tendency in the wider world is to oversimplify. Vastly oversimplify.
And in the world of medical science, that almost always does you a disservice.
Case in point: Dr. Attia and cholesterol
In my last post, I summarized what I consider the essentials to understand cholesterol’s role in heart attacks, the #1 cause of death in America. I referred to tests that most folks have never heard about, including Lp(a) and Apo B. If I speak without interruption, it’s about a 7-minute monologue.
Dr. Peter Attia has a 6 podcast series on the topic. I consider him one of the premier physician educators out there; we live in an age of informational wonder when anyone can access his material, not just medical students at Stanford or Johns Hopkins.
But each podcast is about 2 hours long, call it 12 hours of material. If you’re an MD/PhD candidate aimed at holding your own among others in the field, this is “required reading.”
I cut 12 hours down to 7 minutes.
That’s a 99% trim job.
And even 7 minutes will make some folks wander off.
The Goldilocks options
The best part of the one-on-one visit is that your doctor (hi) can assess your situation and deliver just the appropriate information.
Some people want the firehose. They want to know the citations so they can read the scientific papers. They want to see the chemical formulas, and they want to hear about the cutting-edge controversies. These are the folks who want the whole story of Goldilocks, down to the exact time she set out for the woods, and the temperature of the porridge bowls she cooked for the bears.
Some folks want the good parts version. They want to hear a summary of the key factors, curated by an advisor they trust. So they can then decide if they need additional time for consideration, or if they can proceed with a decision. These folks want the Cliff Notes version of Goldilocks, about the girl who ventured into the woods and learned from a family of bears that one size does not fit all.
Some folks want to be told what to do. Their trust in their healthcare provider is complete, they’re busy as frak, so when can they pick up their prescription? These folks look at the Goldilocks story and say, “Blondie.”
And each of these groups is right. For their needs, the version of the story they want is appropriate.
The problem with trust and Just The Facts
From my standpoint, the problem isn’t that delivering information at any of the 3 levels puts a helluva lot of weight on being trustworthy.
The problem is that sometimes, you don’t know what you don’t know.
A patient may think that they want one form of information, but there’s often a gap between what they want and what they need. Maybe they want the firehose of info, but all the sources they’re accessing are quackery. Maybe they want the good parts version, but their minds are already made up.
And this is when I have to get a little meta. I have to step sideways from the medical material and talk epistemology: the pitfalls of blind spots, and the limits of knowledge. If you’re making confident decisions using poor tools, it’s part of my job to point that out.
If we’re having a talk and we mutually agree on the assumptions and the ground rules for how we’re going to reach a conclusion, the discussion can be straightforward. Chain-smoking cigarettes is no bueno, agreed? You’d rather not die from cancer, heart attack, or emphysema, agreed? Great, now let’s talk about how to quit.
Like playing a game of chess, we can reach a conclusion if we agree that there are different pieces, and we take turns moving one piece at a time. It goes sideways if I think we’re playing chess and you think it’s OK to move 4 pieces at once.
If you’ve ever wondered why a number of my posts are about “deeper insights” instead of straightforward medical recommendations, now you know. Clarifying the plain facts, at any level of detail you need, is simplicity itself.
But often there are underlying blanks to be filled before we can talk turkey. And these are frequently the biggest barriers to progress.