…we resort to politeness strategies when we have to share information that might offend or embarrass someone or information that suggests someone has made a mistake or a bad choice. The more sensitive an issue is, the more likely we are to use these kinds of politeness strategies.
Politeness can become problematic, however, when it causes us to sacrifice clarity. Existing research suggests that politeness strategies can lead to confusion about the meaning of statements that, under other circumstances, would be clear. And this confusion is especially likely to occur in high-stakes situations, the very situations in which we are most likely to use politeness strategies.
Even worse, say the authors, it takes more of our cognitive resources to process these kinds of polite statements. Thus, “[w]e must think harder when we consider the possibility that people are being polite, and this harder thinking leaves us in a greater state of uncertainty about what is really meant.”
This confusion and uncertainty can have particularly negative consequences when safety and security are on the line – such as for pilots trying to fly a plane in an emergency or for a doctor trying to help a patient decide on a treatment. Politeness can also have serious consequences within corporate culture – people don’t want to embarrass their bosses or their co-workers, so they hesitate to point out when something looks amiss, even when potential fraud or misconduct might be involved.
So how can we make sure to get around the confusion of politeness? One option is to encourage people to be more assertive in high-stakes situations. Some companies, including airlines, have even instituted assertiveness training programs, but it’s not yet clear whether these programs really work.
Another option is to try to make the interpretation of polite statements easier for people. “Say that there is a tone, a prosodic feature which typically signals that politeness is at work,” says Bonnefon. If we can identify this tone, we could “train pilots or other professionals to react intuitively to that tone in order to treat it as a warning signal.” …
An investigation published on bmj.com today showed that members of guideline panels in the U.S. and Canada have a high prevalence of conflicts and high numbers of under-reporting conflicts of interest (COI).
The problem of incomplete disclosure is exposed in the investigation, which also underlines the crucial relationship between presence of COI and sponsorship guidelines.
For over 20 years the incidence of COI among industry and clinicians has been a concern for the medical profession.
Because freedom from bias is important, the development of clinical practical guidelines is one area of particular concern for the presence of COI.
Even though the majority of companies that create guidelines have adopted conflict on interest disclosure policies, they are not usually clear, and might not be enough to stop members of guideline panels bias from influencing recommendations. …
- Industry conflicts of interest are pervasive among medical guideline panel members (medicalxpress.com)
Like you, I receive a whole bunch of breaking medical news every day, from television, radio, newspapers, direct mail, email alerts, press releases, and multiple websites.
Is any of it worth my time, my attention, or even a change in my knowledge, attitude, behavior, or medical practice? How can I quickly tell?
A medical journalist from Minnesota named Gary Schwitzer recognized this problem many years ago and created a service that will help all of us, in and outside of medicine and medical journalism, to spend our time and direct our attention wisely.
Schwitzer’s service is called Health News Review and widely publicizes a set of criteria to apply to medical stories reported in the popular media.
While his approach cannot prevent fraud, liars, and fabricators, a careful use of his criteria can help the reader filter out what is likely to be real junk, or even worse, harmful.
Medical Reporting Rules to live (or die) by:
- How available is the treatment/test/product/procedure to the likely reader/viewer/listener at the time of the report?
- What is the cost or charge for the test/treatment/product or procedure mentioned in the story? To the patient? The insurance company? The government?
- Is there evidence of disease mongering in the story? Does it oversell or exaggerate a condition or create unwarranted fear?
- Does the story seem to grasp and convey the quality of the evidence supporting the basis for the study?
- Does the article provide appropriate balance about harms that might be caused by the treatment/test/product/procedure that constitutes the basis for the story?
- Does the story establish the true novelty of the approach? Much that is purported to be new, really is not.
- How does the story frame the relative quantitative value of a new treatment, test, product, or procedure and place the benefits in context with others, especially dealing with absolute and relative values?
- Did the author and editor of the medical news story rely solely or largely on a press release or did they also seek and quote other sources?
- Was there an independent source and were any possible conflicts of interests of sources disclosed in the article?
- Does the story provide the context of treatment/test/product/procedure other than those that are being reported?
- Essential tips for medical journalists (kevinmd.com)
- Comparison of good and bad reporting on leukemia gene therapy (boingboing.net)
- Health Literacy Month Is Back – Tell a Friend (engagingthepatient.com)
Ask most patients, and they say their doctor has a good reason for ordering tests and prescribing treatments. Turns out their doctor may secretly disagree. That’s the conclusion of a new study. The implications are more than a bit disturbing.
Researchers from the Dartmouth Institute for Health Policy conducted a survey of more than six hundred physicians. Forty-two percent of family doctors admitted that patients in their own practice receive too much care – meaning that the doctor was ordering too many blood tests and x-rays and prescribing too many treatments. Only six percent said they were receiving too little. The study was published recently in the Archives of Internal Medicine.
Read the rest of The impact of unnecessary testing and treatment on patients on KevinMD.com.
- Doctors should not treat every patient like their mother (kevinmd.com)
- Americans get too much health care, doctors say (cbsnews.com)
- Many Physicians Feel They’re Delivering Too Much Care (blogs.wsj.com)
- Our easy access to imaging has led to overutilization on KevinMD.com.
- Top 5 Unnecessary Health-care Costs (blogs.wsj.com)
- Well Blog: Doctor and Patient: Why Doctors Order So Many Tests (well.blogs.nytimes.com)
The American Board of Medical Specialties (ABMS) has begun publicly reporting whether specialists are meeting the continuing education requirements necessary for maintaining board certification.
Seven member boards — the American Boards of Dermatology, Family Medicine, Nuclear Medicine, Otolaryngology, Physical Medicine and Rehabilitation, Plastic Surgery, and Surgery — are the first to report via the ABMS.
Information is available on physicians certified by those boards at www.certificationmatters.org.
Search results show the name of the certifying board, and a “yes” or “no” as to whether the physician is meeting the maintenance of certification (MOC) requirements for that board. A link will take the searcher to the certifying board’s explanation of its specific requirements.
The remaining 17 member specialty boards will make maintenance of certification status available through the ABMS by August 2012.
- Clinical Informatics Wins Official Recognition (informationweek.com)
- Physicians Oppose Increased Certification Requirements (bsurgmed.wordpress.com)
- National Medical Society Advises How to Choose a Pain Specialist (prweb.com)
- Universal board certification can solve the Doctor Nurse controversy (kevinmd.com)
Findings challenge one-size-fits-all weight assumptions
Researchers at the National Institutes of Health have created a mathematical model — and an accompanying online weight simulation tool — of what happens when people of varying weights, diets and exercise habits try to change their weight. The findings challenge the commonly held belief that eating 3,500 fewer calories — or burning them off exercising — will always result in a pound of weight loss.
Instead, the researchers’ computer simulations indicate that this assumption overestimates weight loss because it fails to account for how metabolism changes. The computer simulations show how these metabolic changes can significantly differ among people. Findings will be published Aug. 26 in a Lancet issue devoted to obesity.
However, the computer simulation of metabolism is meant as a research tool and not as a weight-loss guide for the public. The computer program can run simulations for changes in calories or exercise that would never be recommended for healthy weight loss. The researchers hope to use the knowledge gained from developing the model and from clinical trials in people to refine the tool for everyone.
“This research helps us understand why one person may lose weight faster or slower than another, even when they eat the same diet and do the same exercise,” said Kevin Hall, Ph.D., an obesity researcher and physicist at the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases and the paper’s first author. “Our computer simulations can then be used to help design personalized weight management programs to address individual needs and goals.”
The online simulation tool based on the model enables researchers to accurately predict how body weight will change and how long it will likely take to reach weight goals based on a starting weight and estimated physical activity. The tool, at http://bwsimulator.niddk.nih.gov/, simulates how factors such as diet and exercise can alter metabolism over time and thereby lead to changes of weight and body fat….
- Judith J. Wurtman, PhD: Are You Losing More Than Fat on Your Diet? (huffingtonpost.com)
team led by Ki Chon, professor and head of biomedical engineering at WPI, has developed a smart phone application that can measure not only heart rate, but also heart rhythm, respiration rate and blood oxygen saturation using the phone’s built-in video camera. The new app yields vital signs as accurate as standard medical monitors now in clinical use. Details of the new technology are reported in the paper “Physiological Parameter Monitoring from Optical Recordings with a Mobile Phone,” published online, in advance of print, by the journal IEEE Transactions on Biomedical Engineering.
- E-Medicine and Smart Phones Manage Chronic Illness (nextbigfuture.com)