People Need Unbiased Information
Third Revolution in Healthcare
The Need for Unbiased Information for the People
The Healthcare Leaders have over the decades focused on ensuring that the medical procedures, equipment, and staff recruitment processes are developed in a way that they offer optimal quality and minimize the risks and cost involved in such processes. However, at the same time it is also necessary that special impetus is laid on the need for a transparent system offering unbiased information to the patients. Several industries have already adapted to such processes that provide a transparent working mechanism to help the patients/customers gain correct knowledge about the system.
Taking inspiration from what the Chief Executive of Toyota once quoted- “Toyota is a knowledge business”, even the healthcare sector has recognized itself to be a knowledge business. The healthcare revolutions in the past had different viewpoints on the healthcare industry. While the second healthcare revolution proclaimed healthcare as a technology business, it was the third industrial revolution, driven by citizens, which revealed that knowledge is the main resource for health industry, and it is the internet that fosters the process of dissemination of this knowledge. It is only through proper and authentic knowledge dissemination that the health service can be provided in the best way to the people whom we call patients.
According to the traditional healthcare processes, it is on the clinicians to inform the patients and the masses about the risks, benefits, and other aspects of a procedure. However, this monopoly of information has now been changed and after recent developments in the healthcare laws, the scope of the right to information regarding medical procedures has widened. Earlier patients were given limited information about the medical procedures and processes and were asked to make a decision regarding their preferences for the treatment. But now it is mandatory that all healthcare institutions provide complete information on the treatment process, cost and other details to help the patient and its family members make an informed decision.
Conducting a research on the healthcare information system in India, it was revealed that “The data available from these sources are often incomplete mainly due to administrative, legal, social and ethical reasons. For example, cancer registration is not legally compulsory, while in practice it is mandatory.” (Pandey et al., 2010). Such loopholes in the information system leads to dissemination of incorrect information to the patients which can lead to adverse detrimental effects on the lives of many individuals. Hence, the need for transparency in the healthcare information system both in the government and private sector is the need of the hour.
The above information raises another concern amongst the patients regarding the credibility of the information provided to them. It creates a bigger challenge about the way the information is disseminated, and the credibility of the information given.
Risk and Benefit Assessment
As per the traditional methods, the caretaker/guardian of the patient has in several instances been asked to take the fateful decision of whether or not to give a green flag for a crucial surgery or treatment such as a hip replacement surgery, heart surgery, etc. Also, in other cases that patients have been asked to undergo procedures such as undergoing a genetic test for a new drug by only explaining them about the risks involved in such processes. It has been assumed by default that the patients are aware of the benefits of the process and procedure. However, this is not true in most cases. Hence, the patients take decisions based on the limited information that they have and only evaluate based on the harm and not the benefits of the same.
However, with rising awareness and changes in the healthcare laws, it is now clear that the patients need to be educated about both the pros and cons of a medical procedure. So, when we talk about risk benefit analysis it means that the benefit is 100%, however, the percentage of risk is uncertain. There have been numerous instances of a medical procedure being 100% successful. Hence, we need to focus on both the probability of benefits and harm to best assess a medical process.
But what is the best way of disseminating this information?
Choosing the Right Terms
When talking about a medical procedure, the use of words such as possible or probable or risk or chance are vague and can be easily misunderstood. Hence, the best approach to provide authentic information is by talking about-
- the probability of benefit and
- the probability of harm
Some individuals may want to discuss about the possibility of risks that may occur or the benefits, but it is always better to use neutral terms such as probability so that the individuals have a clear view of the information being passed on.
Another aspect to focus on is how to pass the same information when numbers are involved?
First and most essential principle is to minimize framing.
Giving Absolute Numbers
During the covid epidemic, David Spiegelhalter, the Winton professor of communication at the University of Cambridge was one of the trusted voices. He has clearly outlined the probabilities and the danger related with the ideas he devised together with another expert in the field, Gerd Gigerenzer. Gigerenzer, the professor at Max Planck in Berlin, was a big influence on David Winton Harding’s The Winton Foundation, a leading foundation in the financial sector, which shows the fact that decision makers in financial institutions made risk decisions that were more logical and consistent than anyone else. This encouraged Winton to finance a chair to examine risk management in each sector.
Putting Risk in Perspective
Risk analysis, especially in the nuclear business, has a long history where risk analysis is essential. The data that involves the proclamation of risk in a particular sector has been used time and again to lure the people in buying one or the other form of services/products. For instance, the proclamation of high flood areas in certain parts of the country, may lure the farmers of the region into buying flood insurance. The same is often applicable in the healthcare industry.
The problem is that we must avoid framing points such as ‘The point of view in which information is given. As, when the same material is given a favorable light and a negative light, different emotional answers are requested.”
There is good evidence that using percentages tends to encourage individuals to make a decision rather than absolute numbers. Hence, two different ways of representing probabilities have arisen from this
- ‘The NNH’, the Number Needed to Harm and
- ‘The NNT’ the Number Needed to Treat
It is much better to convey statistics in absolute numbers than to offer percentages and minimize any distortions.
Fortunately, a number of patient decision-making aids have been issued and it is important that all those taking a false decision are given the opportunity to decide on a defining outcome not only by best current data but by the best current numbers and by means of methods, minimizing bias.
Wisdom drives the third health care revolution, but those that guide and oversee the science must ensure that it is not impartial.
- Woloshin, S., Schwartz, L.M., Welch, H.G. (2008) Know your Chances. Understanding health statistics. University of California Press. (p.122).
- Bell, D.E. et al (1988) Page 11 in: Decision-making. Edited by Bell, D.E. et al. Cambridge. Citing the data from: McNeil, B.J. et al (1982) On eliciting the preferences for alternative therapies. New Eng. J Med. 306: (p.1259-1262).
- Pandey, Arvind & Roy, Nandini & Bhawsar, Rahul & Mishra, Ram. (2010). Health Information System in India: Issues of Data Availability and Quality 1. Demography India. 39. 111-128.