Recently in the comments to a post on Science-Based Medicine we have been having a discussion about the nature of expertise. The post was superficially about tonsillectomy, but really about the relationship between the role of the physician as a medical expert and the role of the health care consumer in being well-informed.
The article was a criticism of a post written by Seth Roberts in which he argued that patients should do their own research (meaning review of published research) and not rely upon the medical establishment, who is biased, self-serving, and ignorant of basic science (according to Roberts).
As you might imagine, I took exception to that characterization. What Roberts actually provided evidence of (and continued to do so in the comments and he dug himself in deeper and deeper) is the folly of non-experts trying to be their own experts, especially in an important area such as health care.
This issue is worth exploring further, as the relationship between doctors and patients specifically, and experts and their clients or the well-informed public in general, has become complicated in our modern society. Conventional thinking within the culture of medicine is to take a thoughtful and nuanced approach to this issue. This contrasts sharply to Robert's straw man - that deferring to experts is the equivalent of "following experts blindly."
As skeptics who advocate scientific literacy and critical thinking, we certainly recognize the value in being well-informed. The medical community also recognizes that value of having well-informed patients. Knowledgeable patients are more compliant with their treatments, they take better care of themselves, and they are better able to provide informed consent.
The old model of patient care (called paternalism), where doctors simply told patients what to do, and even "protected" them from unpleasant information, are long gone. The standard of care today is the cooperative model, which is a good model for the use of experts in general. In this approach physicians are under obligation to provide reasonable informed consent to patients. This stems from a respect for patient autonomy - the right of every individual to control their own destiny.
In the cooperative model patient education is highly valued, as patients become partners in their own health care. Doctors, nurses, and other health care providers are expected to educate patients about their illness and the various management choices. The role of the medical expert is to help patients understand the state of the scientific evidence, and to provide the benefit of their own experience. But the patient (or their parent, etc.) makes the ultimate decision.
We live in world, however, where patients can easily bypass the medical expert, go online and attend "Google University." It is therefore very tempting for patients, especially if they have been told to distrust medical experts, to do their own online research and substitute their own reading of the literature for the prevailing opinions of the medical community.
It is far better for patients to seek out reliable sources of information online to supplement their education about their illness, but to discuss what they find with an expert who can help them put it into context. It is also important to recognize that there is a great deal of misinformation online - some well-meaning and some malignant.
Understanding the medical research on any specific question is very difficult. Anyone who reads Science-Based Medicine regularly will know that there are different kinds of evidence, different ways to look at the evidence, different ways to statistically analyze data, and many types of considerations to take into account. On complex questions where the data is unclear, experts will disagree.
It should also be clear that on medical questions where the evidence is rock solid, non-experts trying to understand the evidence for themselves (perhaps through the veil of an emotional issue or ideology) can come to conclusions that are in stark contradiction to the expert consensus, and in some cases are flagrantly absurd. There are entire online communities dedicated to misunderstanding and misrepresenting the state of the evidence, such as the anti-vaccine community.
Understanding how to read the medical research, and understanding the details of the research in one area, literally takes years of dedicated study. This should not be surprising, and is the same for any complex area. Analogies help make this point more clear - would you presume to enter the cockpit of a commercial jet and ask to fly the jet because you read a magazine article about it?
We have no choice but to defer to experts in countless areas of our life. Our civilization is simply too complex for anyone to master every aspect of technology and expertise.
What I feel is the optimal approach to take is to make the effort to be "literate" about those areas that are important to your life - medicine, finance, legal, everyday technology, etc. Understand at least the basics so that you can discuss important issues with experts and understand their advice. You also need to understand which professions are science-based and legitimate and which are not.
But do not try to be your own expert when in fact you are not. This does not mean following experts blindly. It means not following yourself blindly.
Steven Novella, M.D. is the JREF's Senior Fellow and Director of the JREF’s new Science-Based Medicine project.
Dr. Novella is an academic clinical neurologist at Yale University School of Medicine. He is the president and co-founder of the New England Skeptical Society and the host and producer of the popular weekly science show, The Skeptics’ Guide to the Universe. He also authors the NeuroLogica Blog.