Education on health, ethics, risks/benefits
It is commonplace that the best decisions are reached upon solid background knowledge of the questions at hand. However, such an ideal situation is rarely the case in real life. Therefore, we are forced to decide based on partial knowledge and insight. Intuition come to our aid together with ethical views and whatever information is available at the time of decision. The downside of this scenario would be best described as a mixture of prejudice, misinformation, and propaganda. Keeping these things apart is not always easy in the middle of action. Knowledge of as many objective facts as possible does help to recognize what is in line with the facts and what appears contradictory.
The internet has put a wealth of information literally at our fingertips as everybody with a computer, tablet, or smart phone can confirm. I deliberately choose the term “information” as this does not make any assumptions about the amount of truth delivered. Facts that can be checked and verified are information, so is any kind of unintentional or intentional misinformation. Only checking against a collection of verified facts allows discerning serious verifiable information from unsubstantiated statements. Claims are no facts and denouncing people who question those claims instead of supporting facts reveals the claims as unsubstantiated propaganda.
Information by nature is initially free of judgment, which it should be and remain ideally. However, information usually comes with a judgment often intermingled with the information and hard to separate. Education and explanation are different as they provide facts underlying the information. However, providing facts and explanations only works if the recipients are also able to understand the provided content. Otherwise attempts of explanation end up as simple claims again which the recipients cannot verify.
This highlights a very important feature of education and explanation. The basis to provide and receive content is mutual respect. If a statement is only backed by a strong “believe me” what is really delivered is mistrust. On the other hand sweeping statements such as “all doctors and scientists are liars anyway” does not help either. In western societies (especially in Europe) respect has been mainly reserved for the teachers while the others were expected to absorb the wisdom as presented. This has certainly changed in the meantime to some extent, but we are still not at the same level for teachers and students. In Asian cultures the same hierarchy is persisting apparently even stronger. However, mutual respect is an integral part of this and teachers bow to their disciples the same way as the other way round. It is not uncommon that teacher explicitly thank their students for their time and devotion, which is not common in western cultures.
A teacher naturally knows more about the facts and connections of his topic than his listeners. However, that does not mean that only his/her views are correct and listeners may come to different conclusions although they got the teacher’s point. This is the basis for a discussion and should not be dismissed upfront. I had the experience in my own life that outsiders sometimes had much better ideas than all the experts, simply because they were not trapped in the same old paradigms as the experts. They came from a different background allowing them to think in different terms.
Figure 5: Successful education requires a dialog
If a teacher wants to reach his/her audience he/she better knowns something about the background of his/her audience. Education and explanations are no one-way street. Optimal transfer of facts and content will work best in mutual communication. That is the exact reason why I chose the format of a blog for this series rather than publish a series of PDFs. I can only improve when I get feedback where to improve and where things are fine the way they are. Dialog produces superior result to any brilliant monologue. This is the realm of books.
I often heard the telling argument in discussions “you need to study this subject for a number of years before you can understand this”. Basically yes, but with a light correction: Whoever uses this argument should study himself/herself a few years learning how to make statement in an intelligible way. For example, I I am interested to get the gist of how a combustion engine works, there is no need to first complete an engineer’s education. The same way I can understand why I should not skip antibiotics after two days just because I feel better without having to become a MD or biologist. In this case the simple explanation would be that bacteria may survive after two days in sufficient numbers to learn how to fight the antibiotic. Next time the effect of the antibiotic will be diminished or even abolished due to the acquired resistance. Taking the antibiotic for the whole prescribed period (usually a week) ensures killing of almost all bacteria. As is well known the dead do not learn any new tricks.
I am quite sure that opinions about this type of explanation will vary - from useful but too much simplified all the way to completely off the mark. I would like to read about these opinions in the comment section as this is the only way for me to improve next time
I think it is feasible to deliver education and explanations in a language that does not depend on deep background knowledge. I can read my watch without knowing how it works in detail. This is not required to help me to be in time for a meeting. There is no need to build a huge pyramid of knowledge just because I get interested in a stone located 60 rows up. I could just look at this stone and its immediate vicinity to get the information I am interested in. With respect to personalized medicine understanding of the basic features of a molecular diagnostic test is possible without a full-blown background in molecular biology. There is no difference if a MD explains an X-ray scan to me despite the fact that I am no radiation physicist or the subject is a gene-based diagnostic test without being a geneticist.
Education and explanation need to take the intended audience into account to be successful. Meaningful explanation has to transport facts, results and diagnosis in a way that at least the principal meaning is directly intelligible to the recipient. One can always ask questions about further details in case of sufficient interest.
In my mind, MDs, scientists, health providers, politicians, and attorneys need to learn about as much as the general public. Meeting in the middle will lead to a meaningful dialog and contribute to an effective translational and truly personalized medicine for all of us.
What’s coming up next?
Next week I want to start more specific topics. The first will be molecular diagnostics, which is a prerequisite of personalized medicine.