Doctors should be more sensitive to the limitations of the evidence, training them to do critical appraisal, & enhancing their communication skills

Ioannidis, J. P. A., Stuart, M. E., Brownlee, S. and Strite, S. A. (), How To Survive the Medical Misinformation Mess. Eur J Clin Invest. Accepted Author Manuscript. doi:10.1111/eci.12834

Abstract: Most physicians and other healthcare professionals are unaware of the pervasiveness of poor quality clinical evidence that contributes considerably to overuse, underuse, avoidable adverse events, missed opportunities for right care and wasted healthcare resources. The Medical Misinformation Mess comprises four key problems. First, much published medical research is not reliable or is of uncertain reliability, offers no benefit to patients, or is not useful to decision makers. Second, most healthcare professionals are not aware of this problem. Third, they also lack the skills necessary to evaluate the reliability and usefulness of medical evidence. Finally, patients and families frequently lack relevant, accurate medical evidence and skilled guidance at the time of medical decision-making. Increasing the reliability of available, published evidence may not be an imminently reachable goal. Therefore, efforts should focus on making healthcare professionals, more sensitive to the limitations of the evidence, training them to do critical appraisal, and enhancing their communication skills so that they can effectively summarize and discuss medical evidence with patients to improve decision-making. Similar efforts may need to target also patients, journalists, policy makers, the lay public and other healthcare stakeholders.

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In our encounters with students, clinicians, and others working in the healthcare industry (including academicians, researchers, editors, peer reviewers, pharmacists, regulators, politicians and employees of insurance companies, hospitals, the pharmaceutical industry and new technology companies), we have found a lack of the basic skills required for determining a study’s reliability and applicability. For example, in a pre-test administered to a sampling of more than 500 physicians, clinical pharmacists and other healthcare professionals attending evidence-based medicine (EBM) training programs in 2002 and 2003, 70 percent failed a simple 3-question critical appraisal training program test. The three pre-test questions were designed to determine if attendees could recognize the absence of a control group, understand the issue of overestimating benefit when provided with relative risk reduction information without absolute difference information, and determine whether an intention-to-treat analysis was performed. Surprisingly, among those who reported feeling confident to evaluate the medical literature, 72 percent failed the test, even with generous criteria for correct answers [25]. We have repeated the same pre-test with various groups each year with similar results.