Time for politicians to learn from clinicians

Abstract

In the battle for the use of facts and evidence in public debate, 2016 might be remembered as a landmark year. It’s a battle that the troops of substantiation seem to have comprehensively lost. We now live in an era of the unsubstantiated soundbite, indeed to put it more accurately, we live in an era of the untrue soundbite. Politicians presenting hunches as facts are confident that their bluff will not be called, and if it is, they are confident that their supporters will care more about the emotional weight of their statements than their accuracy.

This is a woeful state for mankind to have reached, and it has played out publicly in two of the world’s leading democracies, namely in the UK’s Brexit referendum and the US presidential election. A regular feature in the New York Times fact checked the statements that the presidential candidates made during live debates. It made depressing reading. Facts weren’t sacred and comment was throwaway.

Facts and evidence drive the enterprise of medical journals. One of the values of peer review is that it’s meant to make articles more factually correct and evidence-based. That isn’t true, of course. Peer review isn’t good at detecting errors and isn’t always reliable at making articles more robust. That leaves medical journals with a prickly problem as they seek to provide reliable information.

In this pursuit of truth, medical journals might be caught between empiricism and dogmatism.¹ Whichever of those schools they belong to, readers of medical journals face legion professional challenges from how to follow referral guidelines to how to prevent burnout and retain enthusiasm for their careers.^2–4 These issues are exaggerated by a political environment that favours populism over evidence. Only this year, Jeremy Hunt, Secretary of State for Health, upset doctors with his misuse of statistics and evidence.

One way to cope with this reality is to accept that you might have got it wrong. Mistakes are possible and need to be corrected. Ideas might be hard to sustain, in which case they need to be challenged. That's how better medical journals should see it, at least. And, I guess, that is one important differentiator between politicians and clinicians.

Politicians like to peddle ‘truths’, to sound smart and paternalistic – and it’s depressing that this approach seems to resonate increasingly with too much of the public. Clinicians are urged to be open about uncertainty, to accept that they can’t know everything and that patients might know best. This is significant because clinicians have had their own failings with paternalistic behaviour and sounding all-knowing. But clinicians are changing, some more slowly than others; they are changing nonetheless.

Hence, in these times of evidence-free soundbites and ill-informed public debate, medical journals and clinicians must hold the line and reinforce the need for evidence and facts in our decision-making. In doing this, the way clinicians are renegotiating their contract with patients is a lesson to politicians. It might be harder work, but a better future lies in honesty and humility with the public.

References

Howick J. Aulus Cornelius Celsus and ‘empirical’ and ‘dogmatic’ medicine. J R Soc Med 2016; 109: 426–430.

Hayhoe B, Majeed A and Perneczky R. General practitioner referrals to memory clinics: are referral criteria delaying the diagnosis of dementia? J R Soc Med 2016; 109: 410.

Hirayama M and Fernando S. Burnout in surgeons and organisational interventions. J R Soc Med 2016; 109: 400–403.

Lambert TW, Smith F and Goldacre MJ. Changes in factors influencing doctors' career choices between one and five years after graduation: questionnaire surveys of UK doctors. J R Soc Med 2016; 109: 416–425.