Posts tagged ‘knowledge’
I wrote the cover story of Tufts Medicine, Winter 2009, with Dr. Janey Pratt, a surgeon at Mass. General Hospital. The article looks at patient use of the Internet from the physician perspective. The article concludes:
Online resources can help your patients become better educated about medical topics, more confident and comfortable with you and more compliant with treatment. As Anthony Schlaff, director of the M.P.H. program at [Tufts University School of Medicine], notes, “At its best, the Internet is one more tool in the partnership between a physician and patient.” [Bruce] Auerbach, the Massachusetts Medical Society president, couldn’t agree more. “Given that patients are going online,” he says, “the best thing to do is engage them as partners in care.”
The full article can be read at Dr. Google: Your Patients, the Internet, and You.
Hongtu Chen and I, with some inspiration from Larry Prusack, just finished a journal paper on The Impact of the Democratization of Health Information on Elders. Here is the abstract:
Thanks to the Internet, elders have access to an unprecedented amount of health information about diseases and medications. Much of this is information previously only available to medical professionals. The ease of locating – or the democratization of – health information has benefits and drawbacks. The benefits to elders are the ability to learn about all aspects of health whenever they choose. The drawbacks are that, due to lack of medical training and poor health literacy, they may not be able to effectively discern the quality of, comprehend, and use what they find online, and, worse, may rely on what they find online instead of seeking professional medical care.
Steve Denning wrote previously about The democratization of knowledge: anyone can know anything:
“This phenomenon is particularly notable in the spontaneous formation of global communities of interest in the field of medical problems. Patients who were once at the mercy of doctors who had unique access to esoteric medical knowledge now find themselves able to contact other doctors and patients and explore their particular subject, gather new data, discover new leads for treatment, and learn how to cope with side effects. The emerging communities are global in nature. A patient in the US may be able to learn from a doctor in China or a suffering patient in Argentina and vice versa. The sufferers of rare diseases, where perhaps only a few victims exist around the world, can now make contact with each other and share experiences…”
I had an email discussion with Steve yesterday, in which he provided the following update on the Democratization of Health Knowledge:
- the rising resentment of some “experts” to the re-emergence of amateur knowledge, and a certain degree of unwarranted elitism involved in such “expert” attitudes. This resentment seems most marked in fields where the expert’s claim to superior expertise is most shaky e.g. political journalists.
- the reluctance of some “experts” to share if they feel that the knowledge risks being misused or abused.
- the gratitude of other “experts” who often see the amateurs as helpful partners.
- the risk that a little knowledge is a dangerous thing. Alexander Pope: “Drink deep or taste not at all from the Pierian spring.” (That risk is however not limited to amateurs. The radical specialization of medicine means that someone can be an expert in a tiny field, but a real ignoramus in areas of their expertise and make egregious blunders.)
- the reduction of such risk in cases where people have taken on the task of lifelong learning. They become adept at getting up to speed in a completely new field and remain curious, open-minded, imaginative, and rigorous in their exploration of a new field of knowledge. This is important both for amateurs and experts. Atul Gawande’s books document some of these issues in the medical field.
My more recent work has tended to move towards the area of things that are already very well known but are not acted on: what can be done about this?
The irony is that the larger knowledge problem since time immemorial has always been one of demand for knowledge, rather than one of supply of knowledge. Unless this is addressed, increased supply of knowledge doesn’t change things all that much. We don’t need a lot of esoteric web research to know that diet, exercise, smoking, or substance abuse are critical determinants of health and well-being. Yet how many people fail to act on this knowledge?
In organizations, people often know all too well what needs to be done, but often they can’t get others to listen and act. (In the medical field, you don’t need to be a genius to see that the overall cost-effectiveness of the US health system is far from optimal. So why hasn’t change happened?) My work is now aimed mainly at helping people overcome resistance to obviously needed change. I’ve spoken on occasion at medical conferences and discussed the issue with dentists.
Marcus Welby, MD is an anachronism. The family doctor who pays house calls no longer exists except for some anachronists or doctors working in a few specific situations. The show, which ran from 1969-1976, predates the web. Hence Marcus Welby and his assistant probably got most of their medical updates from their monthly JAMA.
The amount of medical knowledge that exists and the amount that medical professionals need to know is constantly growing. Medical literature doubles every 19 years and, for AIDs, every 22 months, according to Tonya Hongsermeier, MD.
How can anyone possibly stay current? This is especially important because of the criticality of the information, not just the amount. As Tonya points out, doctors can be aided by tools that assist them, for example, alerting them to possible negative interactions between medications and other medical risks. Initiatives to codify knowledge and increase patient safety are taking place at Partners Healthcare.
Patients, who had limited access to medical knowledge in Marcus Welby’s days, now have a wealth of information available online – in fact, can access most of what physicians read. However, patients generally lack the basic knowledge and frameworks to understand and make sense of this abundance of readily accessible knowledge and, even more importantly, how to apply it. This is primarily due to lack of medical training and poor health literacy.
This democratization of medical knowledge, according to Larry Prusak, is a double-edged sword. Doctors struggle to stay on top of advances and, at the same time, patients increasingly try to acquire medical knowledge about their own or their loved one’s health. The disconnect between patients and doctors can be attributed in part to this democratization, which has changed the relationships between patients and their providers. The notion of empowered patients is one few could argue with; however an important component of expertise is knowing what you don’t know, knowing what to ignore, and knowing what is important. “There’s so much information (as well as misinformation) in medicine — and, yes, a lot of it can be Googled — that one major responsibility of an expert is to know what to ignore,” but many patients, understandably, lack that expertise as well as the necessary detachment. In fact, even doctors don’t treat themselves.
Not to digress, but I wrote about health and media recently and was interested that Marcus Welby, MD had an episode that focused on the diagnoses of breast cancer in two women, aired when “the wives of two public political figures” had been diagnosed with breast cancer. “The most motivational moment of this episode is James Brolin’s emerging from character to talk about diagnostic and early-detection tools for breast cancer. Such is the hallmark of television that [it] is not only entertaining but informative.” (This also goes to show the amazing information you can find on the internet when you aren’t even looking for it.)
I am at a Working Knowledge conference on “Judgment and Decisions” at Babson College today, organized by Larry Prusak and Tom Davenport. Bob Thomas, Accenture and Fletcher School of Law and Diplomacy at Tufts University, just spoke about “Crucibles, Judgment and Leadership”. One of his main points is that people have to learn how they learn best, and crucible experiences can be pivotal for many people.
The five key ingredients for going from novice to adept expert performer are having talent, ambition, grasp of method, a great teacher, and feedback. Practice can trump talent, as research on expert performance shows. Outstanding performers devise a personal learning strategy that goes beyond practice to understanding how they learn best – and what their passion is. One way Bob learns what people love to do is by asking what they are doing when they lose track of time – what is often called a flow state.
While this talk focused on how businesses grow leaders, I believe Bob’s insights are valid for anyone in any role, including children with learning disabilities, who are explicitly taught how they learn and strategies to accommodate their learning disability. Many people, however, never reflect on their own learning style.
Bob offered a number of examples of crucible experiences in disparate organizations. The Peace Corp drops people into a developing country and expects, with minimal training, they will not only survive, but will learn and grow. The Mormon Church’s major crucible experience is the mission all members go on, which includes dealing with rejection, learning how to resolve conflicts with the person they are on the mission with, and learning what it means to be Mormon in a non-Mormon world. Hell’s Angels’ crucible experience is the run, a long ride where the leader negotiates the passage from one location to the next, making it more challenging than last year’s run.
Tom Davenport led a discussion focused on if – and should – crucible experiences be institutionalized. He gave examples of team-building experiences such as people falling into each other’s arms and fire-walking, but it is arguable if these are crucible experiences.
Even the examples from the Peace Corps, etc., above are orchestrated in a sense. Bob showed videos of two people discussing crucible experiences and they were serendipitous ones, and also ones where it was easy to see that another person, in the same situation, would have been devastated instead of inspired. Part of what I learned from this discussion is that you can prepare people for, and to be receptive to, learning experiences, but can’t necessarily orchestrate them. I would like to better understand the role of reflection and the extent it can be encouraged or scaffolded, since that seems to me to be a major difference between how people learn from a crucible – or any – experience.
Jimmy Wales (founder of Wikipedia) and Rich Baraniuk (founder of Connexions) wrote an op ed piece for the San Francisco Chronicle, which concludes, “Everyone has something to teach. Everyone has something to learn. Together, we can all help transform the way the world develops, disseminates and uses knowledge. Together, we can help make the dream of Open Education a reality.”
I agree that everyone has something to teach but can everyone teach? Can everyone write? As Editor-in-Chief of eLearn Magazine, I have seen submissions with great ideas that were well-written, ones with great ideas that were poorly written, and so on. Clearly not everyone can write, but I still appreciate that they are motivated to express their ideas.
The November 2007 issue of CACM had an article about what motivated Wikipedia contributions and the primary motivation was fun. A blog post “hypothesize[s] that the motivations for participating in volunteer question-answering services are different from participating in projects to create open information sources.”
I would like to hear more about the processes that Jimmy and Rich think should be set up to facilitate knowledge sharing. Will people contribute for fun or will they have other motivations? I thought I knew a lot about Online Health Communities when I wrote the original Wikipedia entry, but what if my self-assessment was flawed? Or what if I was knowledgeable but unable to express my ideas clearly? However, I certainly agree with Jimmy and Rich’s goals.
I also agree specifically about the value of current information, since there are no reasons other than historic for including Pluto in a list of planets. And I know that my college Astronomy course does not qualify me to write about Pluto’s current classification.