Illusion of control

Elias Peter pheski69 at GMAIL.COM
Sun Apr 3 21:19:20 UTC 2016


There is another distinction to be made. Care != diagnosis/treatment.

We can - and often do - treat people appropriately despite having no diagnosis, or a diagnosis that has no effective treatment.
The diagnosis that causes the symptoms may be less distressing or dangerous than the anxiety or confusion that exists alongside - whether or not the diagnosis is made, made correctly, made incorrectly.

I am not suggesting that accurate diagnosis is not important and that diagnostic error should not be minimized. I only want to remind us that making the correct (pathologic) diagnosis and identifying a treatment may not be all that a patient wants or needs.


Peter


> On 2016.04.03, at 4:10 PM, Tom Benzoni <benzonit at GMAIL.COM> wrote:
> 
> There is one important assumption that is implied but, if stated, may clarify:
> What is the likelihood that this patient with this complaint has a disorder that requires diagnosis and intervention?
> I.e., when looking at this question, you must first select those patients for whom, having made the right diagnosis, there exists a treatment that makes a difference (and define that difference.) 
> Then you must select those patients who have a disorder for which no treatment is needed (it will heal/correct/change on its own) but who are given a treatment that is ineffective or harmful. Importantly, because they have been given a diagnosis and treatment, they may be erroneously counted as a success rather than what they really are, a failure. (Most "pulmonary emboli" currently being diagnosed by CT and given NOAC are likely in this group, as are many "cancer survivors.")
> I could go on but I'm stop by Voltaire's suggestion that the art of medicine is amusing the patient while Nature cured the disease.
> tom benzoni
> 
> On Sat, Apr 2, 2016 at 3:34 PM, robert bell <0000000296e45ec4-dmarc-request at list.improvediagnosis.org <mailto:0000000296e45ec4-dmarc-request at list.improvediagnosis.org>> wrote:
> Dear Xavier,
> 
> Could the therapeutic illusion be “real” if the placebo effect was stronger in some patients than others?
> 
> Also, one would also suspect that certain ineffective treatments themselves would have a greater perceived value by some patients than other treatments.
> 
> And certain providers may be better placebo producers than others?
> 
> Isn’t it the placebo effect that drives the $14.4 billion alternative medicine market?
> 
> Rob
>> On Apr 2, 2016, at 5:23 AM, Xavier Prida <dr.xavier.prida at GMAIL.COM <mailto:dr.xavier.prida at GMAIL.COM>> wrote:
>> 
>>> Publication of interest to the society- "The Science of Choosing Wisely-
>>> Overcoming the Therapeutic Illusion".
>>> Although framed by the context of "therapeutic illusion", this readily
>>> translates to "diagnostic illusion"- the cognitive bias of illusion of
>>> control. Perhaps, best embodied behaviorally by overconfidence.
>>> 
>>> 
>> http://www.nejm.org/doi/full/10.1056/NEJMp1516803 <http://www.nejm.org/doi/full/10.1056/NEJMp1516803>. 
>>> 
>>> 
>> 
>> 
>> -- 
>> Xavier E. Prida MD FACC FSCAI
>> Assistant Professor of Medicine
>> USF Morsani College of Medicine
>> Department of Cardiovascular Sciences
>> 2 Tampa General Circle
>> STC 5 th Floor 
>> Tampa, Fl 33606
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> 
> Robert M. Bell, M.D., Ph.C.
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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