Do Smart People Make Dumb Patients?

Do Smart People Make Dumb Patients-A while back, The Daily Beast published an article with the provocative title “Why Smart People are Dumb Patients.” The article talks about undeniably brilliant people such as Steve Jobs making ultimately disastrous health care decisions.

Oddly, the article also focuses on smart people who opt for alternative medicine over evidence-based Western approaches. I don’t think this is the best example of why smart people may be dumb patients.  Rather, I think what we’re seeing is the result of intelligent people having an unprecedented access to information through technology, but not necessarily having the guide rails to help them use it properly.

Smart people have access to tons of information. Sometimes when I’m feeling the beginnings of an illness, I consult my colleague, Dr. Web, M.D., to see what he thinks might be going on. Then I get angry because WebMD somehow always thinks I have something catastrophic, often in the cancer family. Meanwhile it’s something like seasonal allergies related to recent rain. Usually I am able to laugh about the ridiculous results of my health-related web searches, but not always. A few times I have been truly stymied by my symptoms and desperate for answers, and found myself in an Internet rabbit hole learning about various parasitic diseases and rare genetic disorders.

Having access to so much information can make smart people worse patients. It can cause them to request tests for diseases they are very unlikely to have, yes, but perhaps even worse, it can cause them to spend the precious limited moments of their time with their providers having an unnecessary and useless conversation.

This is a strange type of low health literacy; the patient has so much information that they don’t necessarily know which pieces to look at. Rather than being informed about the right thing, they may focus attention on an irrelevant and alarming alternative.

While I would never suggest people not try to educate themselves about their health (and I have no intention of discontinuing my own Google searches), it’s important to temper our expectations of how much we can learn from our own research. For myself, my rule of thumb is if I start getting panicky about what the web suggests I might be sick with, it’s time to step away.

Smart people believe they know how to interpret all that information. Any person with a WiFi connection can access pretty much any published medical information out there. Unfortunately, even the geniuses among us might not know how to use it; in fact, many very smart people who lack scientific or medical training would be hard-pressed to accurately interpret the results of multiple scientific studies.

I believe this is one of the many dysfunctional dynamics at play in the belief of some people that vaccines cause autism. When this belief was first gaining popularity, Andrew Wakefield, a physician in England, published two papers claiming that children receiving the MMR vaccine disproportionately developed autism. Although these papers were later found to include fabrications, along with serious methodological flaws, and although the vast majority of studies in this area do not show a relationship between vaccines and autism, the belief persists. Worse, people who believe it often feel justified as a result of the “research” evidence backing them up.

People who believe vaccines cause autism are not necessarily dumb. Often they have done a lot of reading and research on the topic. But they are also not likely to understand the difference between a peer-reviewed meta-analysis and a handful of anecdotes on an Internet message board. They probably have never worked on peer-reviewed research to understand the process. They have been given information, but without the framework to interpret it properly, they arrive at an incorrect conclusion.

(Worth repeating: This is just one of the many dysfunctional dynamics in the tangled web of beliefs around autism and vaccines.)

You see a much milder version of this same dynamic at play in the health and nutrition arena all the time. According to recent headlines, eating breakfast is not related to losing weight. Eating breakfast also helps you lose weight. What’s going on here? Aside from media outlets trying to get clicks with tempting headlines, you’re seeing people report on the results of a single study as if they were The Truth, rather than as part of a larger pattern of results across a body of studies.

How can a smart person be a smart patient?

Smart people need to strike a balance between being well-informed and empowered patients and deferring to experts where they know best. I believe the most important factor is simply:

Know what you don’t know. Accept that no matter how smart you are, unless you’ve done the basic science prerequisites for medical school, then the medical school education, then your internship, and so on, you’re not likely to know more than your doctor.

Should you be assertive about your own needs (or your child’s)? Absolutely. Should you strive to learn as much as possible about your own health and any illness you have? No doubt. Should you consider your health care team as one of the most important inputs into your knowledge about your health? That may be the key.