Scientists Fail at Science involving Physicians and Politics


The National Academy of Sciences did not shine with the publication of "Democratic and Republican physicians provide different care on politicized health issues." The timing, tone, and content were all wrong. The headline could have been Dems and Reps indicated the same care for six different and usual conditions. Only the indication of difference for three contrived scenarios was used.

The timing was incredibly bad. This is not a nice tribute to Primary Care Physicians on Primary Care Week. Primary care physicians are likely shocked to find out that their care is politically driven. Yale researchers obviously know more than they do.

The tone is bad across title and abstract. This article is a construct of the authors and is not even about actual patient care. Assumption and innuendo need to be left out and reasonable limitations should be included. The headlines about this article are even worse. The National Academy of Sciences stamp has perhaps led journalist to be even less discerning.

The content of the article is worse. Some interpretation is needed so that readers might understand just how far this article strayed. The study involved
  • A small subset of primary care physicians 
  • Who at some past point of time years to many years before, wrote down Democrat or Republican or Independent or no affiliation 
  • Which may or may not reflect their current beliefs and their beliefs may or may not agree with their party affiliation
  • Who performed somewhat differently in various artificial scenarios 
  • Set up by scientists and observed by the scientists and analyzed by the scientists
  • With emphasis on just 3 of the scenarios that revealed some differences, scenarios that are atypical
  • That may have little bearing upon actual patient care. 
  • But this is not what the scientists claimed as their claims go beyond what their research could capture
  • And the scientists that reviewed and approved this article also did not hold them accountable.
  • And the media reporting this have gone even farther
The article and the media did not emphasize the lack of differences across the six areas not artificially constructed - the ones that reflect day to day patient care.
Political Affiliation as a Category

The “scientists” linked some records of some physicians and analyzed the data by political affiliation. Data collected years ago may not reflect current affiliation. It can take years to get around to change a party - or vote. In certain states, political affiliation means little at all because people of both parties register in the dominant party to get a chance to shape primary winners and elections. 

Selection Bias and Low Response Plus Exclusion of Data
The “scientists” got only a 20% participation and then discarded 30% that were not "politicized" enough for the authors. 

This was a time intensive study that also makes it prone to selection bias so only certain physicians participated fully.

The scientists constructed the scenarios. The scientists interpreted the responses. The scientists chose the scenarios to emphasize and report on. The scientists interpreted the responses. The process used was different as compared to real patient-physician interactions. The process including a forcing of the physicians to respond rather than having patients or physicians set the agenda or avoid them.

Poor Assumptions and Failure to Publish Appropriate Limitations

The “scientists” leaped to the huge assumption that an entirely different aspect of a physician’s life (political) that may or may not be important or expressed and can be related to other factors can lead to unwarranted variation in patient care in the professional part of a physician life. Since this is an election year, the timing was best for maximal exposure and exaggeration.

There is no smoking gun. There is no causation. There is not even a real patient impact studied.

The study did not consider other influences regarding the encounter such as team members, patient, patient family, environment, appearance, and verbal clues. 

The “scientists” failed to indicate appropriate limitations and used language that is guaranteed to inflame, blame, and attract attention.
  
Clearly the Republic or Democrat responding physicians (flaming or passive) spanned the full range in their actual responses, but the "scientists" are forced to express their findings in a statistical representation that can be difficult to interpret.

Scenario Versus Real World

It does not appear that the “scientists” were able to structure their research in a realistic way. 

The authors have expressed their bias that physicians do not leave it behind in numerous media postings. People do indeed understand that the people around them have limitations. They certainly understand that physicians have limitations - the media is a constant barrage of such information.

Despite this, physicians attempt to leave it all behind at the door. Most of them if not all have discovered how bad the interaction can go when it is not left behind by them or by the patient. Yes, the patient brings much bias, too. Just read the social media about this.

 when you go in to see a patient - past influences, what the nurse said, what family said, what past physicians said in a record, etc. We are all influenced by who we are, but part of physician training and experience is getting outside who we are.

The fact that not all is left behind is part of being human. 

Republican or Democrat is quite different from being human even though we all tend to forget this fact.


How Do Physicians Learn to Deal with Bias?

If you want to learn something about how physicians deal with their bias, find a way to attend a Balint session. Better yet, form your own Balint group so that you can better function by understanding your own bias. You could also observe physicians interacting with each other or with actual patients. Primary care physician training has been integrated with mental health providers who help shape training. 

Is this what is considered “science”?

Perhaps if scientists were more professional, we would have science that helps us to be more rather than making us appear less.


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Primary care can be recovered and should be recovered, 
but cannot be recovered when moving the wrong directions

Robert C. Bowman, M.D.        Robert.Bowman@DignityHealth.org

The blogs represent the opinion of the blogger alone.
Copyright 2016

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