Illusion of control

Elias Peter pheski69 at GMAIL.COM
Mon Apr 4 00:05:50 UTC 2016


Indeed, that is a delightful discussion.  Thank you.

I was fortunate. My father was an oncologist who corrected people when they introduced him as a doctor who treated cancer: “I treat people. Lots of times they have cancer.” I was also fortunate to spend my medical school training years in Rochester, NY where I was exposed to George Engel while he was developing and talking about his biopsychosocial model (his often cited Science paper was published in 1977, the year I finished my residency).



Peter



> On 2016.04.03, at 6:30 PM, Xavier Prida <dr.xavier.prida at GMAIL.COM> wrote:
> 
> Peter, 
> It is all about context and satisfaction(diagnostician and patient). Patient satisfaction which is now being universally measured does in some diagnostic categories(e.g. acute MI) correlate with outcome. 
> 
> Read this beautiful reflection of the anthropological necessity of care deliver and that which is meaningful to patients.
> 
> http://www.mayoclinicproceedings.org/article/S0025-6196(11)65233-6/fulltext <http://www.mayoclinicproceedings.org/article/S0025-6196(11)65233-6/fulltext>
> 
> Xavier
> 
> On Sun, Apr 3, 2016 at 5:19 PM, Elias Peter <pheski69 at gmail.com <mailto:pheski69 at gmail.com>> wrote:
> 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 <mailto: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
>>> 813 259 0992 <tel:813%20259%200992>(O)
>>> 813 831 0721 <tel:813%20831%200721>(H)
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>>> 
>>> 
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>> 
>> Robert M. Bell, M.D., Ph.C.
>> P.O. Box 3668
>> West Sedona, AZ  86340-3668
>> USA
>> Tel: Fax: 928 203-4517 <tel:928%20203-4517>
>> 
>> 
>> 
>> 
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> 
> 
> 
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> 
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> 
> -- 
> 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
> 813 259 0992(O)
> 







Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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