How to avoid the goat – Information Asymmetries in healthcare
By Daniël Erasmus
“The doctor said so.” One of the most powerful phrases in the English language. It can stop any argument, countervailing opinion or an alternative course of action dead in its tracks. It has been used to great effect in justification of many a pre-test mystery illness, exercise-related evasive action and duvet covered day. It is the irrefutable last words. Or at least it used to be…
From primitive times there have been wise men and women that have administered treatment. They were revered by their communities and afforded a high status in society. In thousands of years of development not much has changed. Until very recently it was considered a mild form of insanity to argue with them: the doctor.
That is because healthcare is complicated, and it is only getting worse. New treatments, diseases and technology have served to increase the permutations of available courses of action. The result is that today many patients in the healthcare system are faced with a problem not too dissimilar to the Monty Hall¹ problem played out in the television series of the 70’s called Let’s make a deal. Contestants were afforded the choice of three doors, 2 containing goats and one containing a car. Unless you were a budding goat farmer, most were hoping to choose the door with the car.
¹The Monty Hall problem was a mathematical and statistical question that created a bit of controversy back in the day.
In healthcare, it used to be that we relied solely on the doctor to assist us with which door to choose. They were the curators of our choices and had the information to see backstage where the car was waiting. But the impact of a wrong door can be costly and nowhere are the stakes higher than getting it wrong if you or your families’ health is on the line.
Today we have options and increasingly more patients are relying on a range of other sources of information to make their choices. Second opinions have given way to Doctor Google and virtual diagnoses tools. This has led to a new trend of pre-diagnosed patients. Many a doctor now find themselves faced with a slew of patients, with their ailment already diagnosed via the world wide web – with a treatment plan in hand. They visit the doctor simply looking for the rubber stamp of a flesh and bone physician to allow them the legal access to the drugs they already know they need.
But the internet is vast and while more information is always better, one should be cognisant of the credibility placed on the results of a google search. Yes, that stomach ache could be cancer, or it could just be the extra slice of cake you had at lunch. In the context of the “Let’s make a deal” analogy, this is not too dissimilar to listen to the portion of the crowd shouting for the door you already like. The question is how you curate all the information available in the information age?
In healthcare three methods have emerged as frontrunners in the curation of healthcare data:
Our ability to program machines to make our lives easier has grown in leaps and bounds. For healthcare, this manifests in many ways, for example as algorithms that are about as good as the best dermatologist at identifying skin cancer. AI is a great tool for overcoming information asymmetries and assisting doctors and patients in diagnoses, better treatment modalities as well as preventative measures.
Information technology has allowed patients to connect with other patients across geographical and cultural boundaries. This has allowed for questions, treatments and answers to reflect the results of a whole population rather than one person’s experience. This method is particularly effective in chronic disease management and recovery.
Technology has increased our access to information but has also increased our access to expertise. The two are not the same. Expert curatorship refers to a group of experts reviewing a question and crafting an appropriate response based on the collective view. This has been used very effectively in medicine and allows patients to distil the information they have at hand with the benefit of a direct and personalised response.
In writing this I am reminded of an episode recently that made me realise that the world has changed a lot since I was a child. My 6-year-old asked me a question about birds. Like most questions originating from the mind of a 6-year-old, it soon turned into a series of questions. Eventually, the stream of questions forced me to utter the phrase that any parent dreads “Mmmm, I am actually not sure about that…” Without flinching my daughter turned to me and said, “Why don’t you just google it”.
As participants in the healthcare market, we need to make sure that we move with her generation and keep up. In her mind the idea of a machine knowing more than a person, a doctor, a panel of doctors, even her dad, is already well established and “the doctor said so” is likely not going to be in her vocabulary.
Here is the question: If you are on the show “Let’s Make a Deal” and you pick a door, say No. 1, and the host, who knows what’s behind the doors, opens another door, say No. 3, which has a goat. He then says to you, “Do you want to pick door No. 2?” Is it to your advantage to switch your choice?
Let us know here what you think is statistically in your best interest (no cheating by curating your answer with a google search…)