D on’t believe everything you hear, and while you’re at it, you probably shouldn’t believe what you see, either. A thinking physician learns from his experiences, right? Sure we do. Do enough of procedure X and you’ll be an expert at said procedure — you’ll know all the ins and outs of that surgical procedure. Our experiences train us to become authorities in the particulars of our profession. Or is that just what we’ve been told? Is this just how we’ve been trained to think since that first anatomy class in which we were collectively inundated in the fine art of memorization? When the camera of our lives pulls back and we take a broader look at the entirety of medicine and public health, what we see are not the particulars of one specialist’s experiences; instead we see trends and interrelationships, diversity and the collective experience of all medical practitioners. Seeing the Whole Picture Five years ago, an investment banker called to ask my opinion about the newest treatment for psoriasis — tumor necrosis factor (TNF) inhibitors. At the time, I told the banker that I didn’t believe the drugs were effective psoriasis treatments. I had been sharing the care of many patients with a rheumatologist who regularly prescribed TNF inhibitors for the treatment of psoriatic arthritis, but I had never seen a single patient whose psoriasis had cleared with the TNF treatment. In retrospect — as is always the case — my error in judgment was completely understandable. Any patient whose psoriasis had cleared with TNF treatment for their arthritis would have no reason to see a dermatologist. I only saw the failures; my particular experience with TNF inhibitors was completely unrepresentative of the true effectiveness of the treatments. My opinion was clouded by referral bias. Judging a Book By Its Cover Think about this little anecdote the next time you hear someone say that in their experience tanning beds aren’t effective for psoriasis. Hold it to heart when you hear an academic dermatologist say that systemic steroids for psoriasis almost always cause pustular flares. And consider it the next time you entertain the thought that primary-care doctors don’t know the first thing about managing skin diseases. Referral bias is a powerful force. Next month, we’ll explore more examples of this bias. Steven R. Feldman, M.D., Ph.D. Chief Medical Editor P.S. If you have examples that you’d like to share, e-mail them to me at sfeldman@wfubmc.edu.
A Matter of Perspective
D on’t believe everything you hear, and while you’re at it, you probably shouldn’t believe what you see, either. A thinking physician learns from his experiences, right? Sure we do. Do enough of procedure X and you’ll be an expert at said procedure — you’ll know all the ins and outs of that surgical procedure. Our experiences train us to become authorities in the particulars of our profession. Or is that just what we’ve been told? Is this just how we’ve been trained to think since that first anatomy class in which we were collectively inundated in the fine art of memorization? When the camera of our lives pulls back and we take a broader look at the entirety of medicine and public health, what we see are not the particulars of one specialist’s experiences; instead we see trends and interrelationships, diversity and the collective experience of all medical practitioners. Seeing the Whole Picture Five years ago, an investment banker called to ask my opinion about the newest treatment for psoriasis — tumor necrosis factor (TNF) inhibitors. At the time, I told the banker that I didn’t believe the drugs were effective psoriasis treatments. I had been sharing the care of many patients with a rheumatologist who regularly prescribed TNF inhibitors for the treatment of psoriatic arthritis, but I had never seen a single patient whose psoriasis had cleared with the TNF treatment. In retrospect — as is always the case — my error in judgment was completely understandable. Any patient whose psoriasis had cleared with TNF treatment for their arthritis would have no reason to see a dermatologist. I only saw the failures; my particular experience with TNF inhibitors was completely unrepresentative of the true effectiveness of the treatments. My opinion was clouded by referral bias. Judging a Book By Its Cover Think about this little anecdote the next time you hear someone say that in their experience tanning beds aren’t effective for psoriasis. Hold it to heart when you hear an academic dermatologist say that systemic steroids for psoriasis almost always cause pustular flares. And consider it the next time you entertain the thought that primary-care doctors don’t know the first thing about managing skin diseases. Referral bias is a powerful force. Next month, we’ll explore more examples of this bias. Steven R. Feldman, M.D., Ph.D. Chief Medical Editor P.S. If you have examples that you’d like to share, e-mail them to me at sfeldman@wfubmc.edu.
D on’t believe everything you hear, and while you’re at it, you probably shouldn’t believe what you see, either. A thinking physician learns from his experiences, right? Sure we do. Do enough of procedure X and you’ll be an expert at said procedure — you’ll know all the ins and outs of that surgical procedure. Our experiences train us to become authorities in the particulars of our profession. Or is that just what we’ve been told? Is this just how we’ve been trained to think since that first anatomy class in which we were collectively inundated in the fine art of memorization? When the camera of our lives pulls back and we take a broader look at the entirety of medicine and public health, what we see are not the particulars of one specialist’s experiences; instead we see trends and interrelationships, diversity and the collective experience of all medical practitioners. Seeing the Whole Picture Five years ago, an investment banker called to ask my opinion about the newest treatment for psoriasis — tumor necrosis factor (TNF) inhibitors. At the time, I told the banker that I didn’t believe the drugs were effective psoriasis treatments. I had been sharing the care of many patients with a rheumatologist who regularly prescribed TNF inhibitors for the treatment of psoriatic arthritis, but I had never seen a single patient whose psoriasis had cleared with the TNF treatment. In retrospect — as is always the case — my error in judgment was completely understandable. Any patient whose psoriasis had cleared with TNF treatment for their arthritis would have no reason to see a dermatologist. I only saw the failures; my particular experience with TNF inhibitors was completely unrepresentative of the true effectiveness of the treatments. My opinion was clouded by referral bias. Judging a Book By Its Cover Think about this little anecdote the next time you hear someone say that in their experience tanning beds aren’t effective for psoriasis. Hold it to heart when you hear an academic dermatologist say that systemic steroids for psoriasis almost always cause pustular flares. And consider it the next time you entertain the thought that primary-care doctors don’t know the first thing about managing skin diseases. Referral bias is a powerful force. Next month, we’ll explore more examples of this bias. Steven R. Feldman, M.D., Ph.D. Chief Medical Editor P.S. If you have examples that you’d like to share, e-mail them to me at sfeldman@wfubmc.edu.
