February 14, 2021

Confusions in Health Advices: A Personal Study

Written by: Mubashar Rehman, PHD

It's common for people to experience conflicting advice from professionals. Frequently, a physician makes a diagnosis of your ailment and prescribes a treatment. Not feeling confident about the findings, you go for a second opinion, who may diagnose you differently and/or changes how you approach the disease. This confusion in health advice can be frustrating and makes you think about whether doctors know what they are doing. You may also feel exhausted wondering if they are listening to their patients and making an informed decision.

Scientists have evaluated 3000 randomized controlled clinical trials published in the top three medical journals (the Journal of the American Medical Association, the Lancet, and the New England Journal of Medicine) and found that 13% of the recent clinical trials contradicted the existing medical practices. Contradiction, in my opinion, is natural. The medical field is considered a life-saving profession, and contradictions should serve as a ground to improve our understanding of health.

Personal Experience of the Doctor

Conflicts in medical advice are usually due to differences in the personal experience of doctors. For example, some physicians would like to prescribe antibiotics for a sore throat to avoid further complications. However, most clinicians avoid antibiotics because they offer no therapeutic value and are prohibited by recent medical guidelines. Additionally, emerging medical literature indicates that the irrational prescription of antibiotics can lead to its resistance and can cause disturbance of microbial flora in the body. Some doctors may also encounter patients that pressure them to prescribe medicine even when they don't need any.

The personal experience of doctors is also based on the population they are serving. Medications are shown to work differently in different people due to varying genetics, dietary habits, and physiological status, ultimately defining physicians' choices.

Social and Political Interest 

Doctors also contradict each other due to social and political interests. Whether doctors should participate in state-ordered executions is a long term example of this issue. Those who oppose the idea of physicians' participation claim that this is against the spirit of medical sciences that are aimed to save lives; the American Medical Association states that "white-coated healers" should not be confused with the "black-hooded executers". However, its supporters believe that doctors' involvement in execution should include medical knowledge to make it more humane. In fact, a study found evidence that many prisoners who were executed by lethal injection in California state might have suffered from suffocation and intense pain. You cannot simply overturn the opinion of either school of thought.

Irrational Medical Practice

The medical field is advancing exponentially, and we are getting accustomed to seeing new medicines and other treatment modalities every week. This requires medical professionals to update themselves with the latest diagnostic and treatment options continuously. Ideally, doctors must take continuing medical education to stay current with medical sciences, but many fail to do this. A recent editorial published in American Family Physicians found that modern American physicians are slow to adopt the evidence-based practice. The current medical research is probably published mainly in scientific journals that are restricted to subscribers, and mostly busy doctors cannot read it. Sometimes, the new treatment strategies do not always cause better patient outcomes leading to discontinuations. Doctors are then inclined to follow the previous practices to which they are accustomed. In my opinion, medical representatives should promote rationale-prescribing practice to help educate doctors on the latest technology and treatments available, as proven by the rapid adoption of non-steroidal anti-inflammatory drugs in the twentieth century. However, doctors should be ultimately responsible for staying up to date and expanding their medical knowledge to give better advice.

Contradictions in Health Sciences

Patients are becoming more vocal on why doctors contradict each other. Just browsing the internet, you will find many people sharing examples of their confusing experiences. Likewise, doctors are reported to contradict more often in the case of pain killers and antibiotics use. Many people also say that doctors frequently disagree with allied health practitioners. However, this contradiction may be due to the different types of knowledge and skills they possess. Allied health professionals are increasingly recognized for their expertise. Doctors, nurses, and other allied health practitioners should continue working together in healthcare teams to possess multidisciplinary knowledge and apply a more holistic approach in coming up a solution to a problem.

Hottest Medical Controversy: The Coronavirus Disease

The current coronavirus pandemic is just one example of having confusing medical advice. Lockdown has been a strategy preferred by clinicians and epidemiologists throughout history to control pandemics. It is widely believed that the complete lockdown of disease hotspot from coronavirus, as advised by most health practitioners, has saved humankind from losing a big part of it. However, a study has shown that the lockdown has made access to health difficult for most people, including those who needed special attention or monitoring.

Additionally, a big controversy was raised in April 2020 when two Emergency Care Physicians in the USA, each of whom has more than 20 years of experience in immunology and microbiology, held a press conference to warn that social isolation can bring more harm than benefits. The human immune system is based on exposure to antigens, and restricting ourselves in our homes can compromise immunity. Indeed, the hope of controlling coronavirus disease is herd immunity, i.e., immunity acquired by a population due to previous exposure or vaccination of masses. The coronavirus pandemic has highlighted the gap of knowledge between physicians and other medical sciences, such as immunology and microbiology, and their consequences in emergency situations. Could the pandemic have been handled better if medical practitioners with multidisciplinary knowledge were involved in decision making?

References:

  1. https://pubmed.ncbi.nlm.nih.gov/31182188/
  2. https://doi.org/10.1056/NEJMe0800032
  3. https://onlinelibrary.wiley.com/doi/full/10.1111/bjh.16782
  4. Physicians, Nurses and Allied Health Professionals Open Door Forum | CMS
  5. Signatures - Great Barrington Declaration (gbdeclaration.org)
  6. https://www.aafp.org/afp/2018/1215/p709.html
  7. Why do general practitioners prescribe antibiotics for sore throat? Grounded theory interview study | The BMJ
Article written by Mubashar Rehman, PHD
Dr. Mubashar Rehman, Pharm D, Ph.D, is an Assistant Professor of Pharmaceutical Sciences in the Quaid-i-Azam University, Pakistan. Dr. Rehman is teaching undergraduate students and supervising post-graduate students in the Department of Pharmacy which is ranked in world’s top 300 institutes by the QS World University Ranking. His research is mainly focused on enhancing therapeutic outcome and reducing side effects of current medications to improve quality of life of the patients. His group is striving to achieve this goal by devising new approaches in healthcare provision, drug delivery systems, medical devices and other health-care interventions. Dr. Rehman has authored more than 30 articles and 3 book chapter with leading publisher such as Elsevier, Royal Society of Chemistry, Nature publishing group and Springer.

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