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[Sushan]

This topic is about the May 2024 Philosophy Book of the Month, Neither Safe Nor Effective (2nd Edition): The Evidence Against the COVID Vaccines by Dr. Colleen Huber

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What is your overall opinion and rating of Neither Safe Nor Effective (2nd Edition): The Evidence Against the COVID Vaccines by Dr. Colleen Huber. What did you like about it? What did you dislike about it? Why? What did you learn new from the book?

What is your overall opinion of the book in terms of its philosophical content?

[LuckyR]

Well, the author is a Naturopath who practices Oncology. Yup, you heard me, she "treats" cancer, which is interesting since she doesn't describe ever having completed a residency, let alone an Oncology fellowship.

To be fair she's more of an author of books (like this one), than a practicing physician. Since Googling her name yields about 20 references to her books before her practice comes up.

Though for laughs Google her name and "quack".

[Sushan]

Well, the author is a Naturopath who practices Oncology. Yup, you heard me, she "treats" cancer, which is interesting since she doesn't describe ever having completed a residency, let alone an Oncology fellowship.

To be fair she's more of an author of books (like this one), than a practicing physician. Since Googling her name yields about 20 references to her books before her practice comes up.

Though for laughs Google her name and "quack".

I followed your suggestion and came across a webpage (https://www.mcgill.ca/oss/article/quack ... treatments) which discusses a case where naturopath Colleen Huber, known for promoting unproven cancer treatments, is suing whistleblower Britt Marie Hermes for defamation in what seems to be a strategic lawsuit against public participation (SLAPP). Hermes, a former naturopath turned science advocate, has been critical of dubious practices within naturopathy. The lawsuit is viewed as an attempt by Huber to suppress Hermes's criticism of these questionable medical practices.

I couldn't find the outcome of this lawsuit or confirm whether Huber's methods are indeed unscientific. However, writing a book that performs a sort of meta-analysis (though not an actual one, and potentially selectively using data and facts) could still be seen as credible if the author possesses sufficient knowledge in the field.

But then this leads us to question whether the author is inherently dishonest, which poses a dilemma. What are your thoughts?

[LuckyR]

Well, the author is a Naturopath who practices Oncology. Yup, you heard me, she "treats" cancer, which is interesting since she doesn't describe ever having completed a residency, let alone an Oncology fellowship.

To be fair she's more of an author of books (like this one), than a practicing physician. Since Googling her name yields about 20 references to her books before her practice comes up.

Though for laughs Google her name and "quack".

I followed your suggestion and came across a webpage (https://www.mcgill.ca/oss/article/quack ... treatments) which discusses a case where naturopath Colleen Huber, known for promoting unproven cancer treatments, is suing whistleblower Britt Marie Hermes for defamation in what seems to be a strategic lawsuit against public participation (SLAPP). Hermes, a former naturopath turned science advocate, has been critical of dubious practices within naturopathy. The lawsuit is viewed as an attempt by Huber to suppress Hermes's criticism of these questionable medical practices.

I couldn't find the outcome of this lawsuit or confirm whether Huber's methods are indeed unscientific. However, writing a book that performs a sort of meta-analysis (though not an actual one, and potentially selectively using data and facts) could still be seen as credible if the author possesses sufficient knowledge in the field.

But then this leads us to question whether the author is inherently dishonest, which poses a dilemma. What are your thoughts?

When our daughter was quite young, I convinced her that Superpowers were real. Two of them were mind reading and knowing the future. The key to mind reading (knowing what other people were thinking and thus what they were going to do in the future) is knowing what their motivation is.

This person is a Naturopath, and thus likely a frustrated Medical doctor (who couldn't get into Med school). Likely isn't making a ton of money, nor getting the respect she thinks she deserves. Thus she has sought accolades in the book writing world. Obviously, almost no one cares about mainstream Naturopathy, hence her staking her claim on "controversial" viewpoints on mainstream topics (like the one you cited).

Obviously, none of the above means that it is impossible for her to come up with a well researched, thoughtful review of a topic with admittedly more than a single perspective. However, common things happen commonly. And in my experience, marginally legitimate sources rarely, if ever, produce high quality content. Thus I am predicting this book is not in that category.

[Imeegerlie]

The author states how to treat cancer. It is fascinating for me because it involves COVID-19 19 which susceptible area to talk about. I'm impressed because the author has no fear of writing about it. It's amazing knowing about the book that can give ideas on how to prevent such kind of illnesses.

[Sushan]

The author states how to treat cancer. It is fascinating for me because it involves COVID-19 19 which susceptible area to talk about. I'm impressed because the author has no fear of writing about it. It's amazing knowing about the book that can give ideas on how to prevent such kind of illnesses.

While I might not share your views on everything you've expressed admiration for, I do concur that the author has demonstrated considerable courage in writing a critical exposé on one of the most formidable forces globally—the pharmaceutical industry.

[Sushan]

Well, the author is a Naturopath who practices Oncology. Yup, you heard me, she "treats" cancer, which is interesting since she doesn't describe ever having completed a residency, let alone an Oncology fellowship.

To be fair she's more of an author of books (like this one), than a practicing physician. Since Googling her name yields about 20 references to her books before her practice comes up.

Though for laughs Google her name and "quack".

I followed your suggestion and came across a webpage (https://www.mcgill.ca/oss/article/quack ... treatments) which discusses a case where naturopath Colleen Huber, known for promoting unproven cancer treatments, is suing whistleblower Britt Marie Hermes for defamation in what seems to be a strategic lawsuit against public participation (SLAPP). Hermes, a former naturopath turned science advocate, has been critical of dubious practices within naturopathy. The lawsuit is viewed as an attempt by Huber to suppress Hermes's criticism of these questionable medical practices.

I couldn't find the outcome of this lawsuit or confirm whether Huber's methods are indeed unscientific. However, writing a book that performs a sort of meta-analysis (though not an actual one, and potentially selectively using data and facts) could still be seen as credible if the author possesses sufficient knowledge in the field.

But then this leads us to question whether the author is inherently dishonest, which poses a dilemma. What are your thoughts?

When our daughter was quite young, I convinced her that Superpowers were real. Two of them were mind reading and knowing the future. The key to mind reading (knowing what other people were thinking and thus what they were going to do in the future) is knowing what their motivation is.

This person is a Naturopath, and thus likely a frustrated Medical doctor (who couldn't get into Med school). Likely isn't making a ton of money, nor getting the respect she thinks she deserves. Thus she has sought accolades in the book writing world. Obviously, almost no one cares about mainstream Naturopathy, hence her staking her claim on "controversial" viewpoints on mainstream topics (like the one you cited).

Obviously, none of the above means that it is impossible for her to come up with a well researched, thoughtful review of a topic with admittedly more than a single perspective. However, common things happen commonly. And in my experience, marginally legitimate sources rarely, if ever, produce high quality content. Thus I am predicting this book is not in that category.

You make some interesting points about understanding motivations as a way to predict behavior, and it's true that background and circumstances can influence someone's actions and decisions. However, it's also important to remember not to rely solely on assumptions when judging a person's work or character. Instead, we should look at the facts available to us.

For instance, a recent real-world example that might lend some credibility to the author's controversial viewpoints is the acknowledgment by AstraZeneca in a lawsuit that their vaccine caused side effects. This case shows that even mainstream medical entities can have issues, which suggests that alternative perspectives, like those the author might offer, could have merit.

What are your thoughts on this development with AstraZeneca? Do you think it impacts the validity of the author's arguments?

[LuckyR]

Well, the author is a Naturopath who practices Oncology. Yup, you heard me, she "treats" cancer, which is interesting since she doesn't describe ever having completed a residency, let alone an Oncology fellowship.

To be fair she's more of an author of books (like this one), than a practicing physician. Since Googling her name yields about 20 references to her books before her practice comes up.

Though for laughs Google her name and "quack".

I followed your suggestion and came across a webpage (https://www.mcgill.ca/oss/article/quack ... treatments) which discusses a case where naturopath Colleen Huber, known for promoting unproven cancer treatments, is suing whistleblower Britt Marie Hermes for defamation in what seems to be a strategic lawsuit against public participation (SLAPP). Hermes, a former naturopath turned science advocate, has been critical of dubious practices within naturopathy. The lawsuit is viewed as an attempt by Huber to suppress Hermes's criticism of these questionable medical practices.

I couldn't find the outcome of this lawsuit or confirm whether Huber's methods are indeed unscientific. However, writing a book that performs a sort of meta-analysis (though not an actual one, and potentially selectively using data and facts) could still be seen as credible if the author possesses sufficient knowledge in the field.

But then this leads us to question whether the author is inherently dishonest, which poses a dilemma. What are your thoughts?

When our daughter was quite young, I convinced her that Superpowers were real. Two of them were mind reading and knowing the future. The key to mind reading (knowing what other people were thinking and thus what they were going to do in the future) is knowing what their motivation is.

This person is a Naturopath, and thus likely a frustrated Medical doctor (who couldn't get into Med school). Likely isn't making a ton of money, nor getting the respect she thinks she deserves. Thus she has sought accolades in the book writing world. Obviously, almost no one cares about mainstream Naturopathy, hence her staking her claim on "controversial" viewpoints on mainstream topics (like the one you cited).

Obviously, none of the above means that it is impossible for her to come up with a well researched, thoughtful review of a topic with admittedly more than a single perspective. However, common things happen commonly. And in my experience, marginally legitimate sources rarely, if ever, produce high quality content. Thus I am predicting this book is not in that category.

You make some interesting points about understanding motivations as a way to predict behavior, and it's true that background and circumstances can influence someone's actions and decisions. However, it's also important to remember not to rely solely on assumptions when judging a person's work or character. Instead, we should look at the facts available to us.

For instance, a recent real-world example that might lend some credibility to the author's controversial viewpoints is the acknowledgment by AstraZeneca in a lawsuit that their vaccine caused side effects. This case shows that even mainstream medical entities can have issues, which suggests that alternative perspectives, like those the author might offer, could have merit.

What are your thoughts on this development with AstraZeneca? Do you think it impacts the validity of the author's arguments?

Oh, my prediction isn't designed to replace a thoughtful and open review of her work (complete with my own research). It's to decide whether or not to devote my time and energy to taking on that task at all (time being my most valuable asset currently). Alas, I will not perform that task, for the previously stated reasons.

As to the issue of VITT with the AZ vaccine, although there isn't currently a known mechanism, or even a theory of a mechanism for it, I have no problem assuming that there is a causal relationship between the two. Of course I am familiar with the concept of relative risk, or to put it another way, only the very naive or extremely inexperienced assume that any entity contains only positives (and no negatives). Thus I have no problem taking on a 1 in 100,000 risk of a serious condition to dramatically lower my risk for another illness that KILLED 1,000 in 100,000 and caused long Covid in 30,000 in 100,000.

[Sushan]

I followed your suggestion and came across a webpage (https://www.mcgill.ca/oss/article/quack ... treatments) which discusses a case where naturopath Colleen Huber, known for promoting unproven cancer treatments, is suing whistleblower Britt Marie Hermes for defamation in what seems to be a strategic lawsuit against public participation (SLAPP). Hermes, a former naturopath turned science advocate, has been critical of dubious practices within naturopathy. The lawsuit is viewed as an attempt by Huber to suppress Hermes's criticism of these questionable medical practices.

I couldn't find the outcome of this lawsuit or confirm whether Huber's methods are indeed unscientific. However, writing a book that performs a sort of meta-analysis (though not an actual one, and potentially selectively using data and facts) could still be seen as credible if the author possesses sufficient knowledge in the field.

But then this leads us to question whether the author is inherently dishonest, which poses a dilemma. What are your thoughts?

When our daughter was quite young, I convinced her that Superpowers were real. Two of them were mind reading and knowing the future. The key to mind reading (knowing what other people were thinking and thus what they were going to do in the future) is knowing what their motivation is.

This person is a Naturopath, and thus likely a frustrated Medical doctor (who couldn't get into Med school). Likely isn't making a ton of money, nor getting the respect she thinks she deserves. Thus she has sought accolades in the book writing world. Obviously, almost no one cares about mainstream Naturopathy, hence her staking her claim on "controversial" viewpoints on mainstream topics (like the one you cited).

Obviously, none of the above means that it is impossible for her to come up with a well researched, thoughtful review of a topic with admittedly more than a single perspective. However, common things happen commonly. And in my experience, marginally legitimate sources rarely, if ever, produce high quality content. Thus I am predicting this book is not in that category.

You make some interesting points about understanding motivations as a way to predict behavior, and it's true that background and circumstances can influence someone's actions and decisions. However, it's also important to remember not to rely solely on assumptions when judging a person's work or character. Instead, we should look at the facts available to us.

For instance, a recent real-world example that might lend some credibility to the author's controversial viewpoints is the acknowledgment by AstraZeneca in a lawsuit that their vaccine caused side effects. This case shows that even mainstream medical entities can have issues, which suggests that alternative perspectives, like those the author might offer, could have merit.

What are your thoughts on this development with AstraZeneca? Do you think it impacts the validity of the author's arguments?

Oh, my prediction isn't designed to replace a thoughtful and open review of her work (complete with my own research). It's to decide whether or not to devote my time and energy to taking on that task at all (time being my most valuable asset currently). Alas, I will not perform that task, for the previously stated reasons.

As to the issue of VITT with the AZ vaccine, although there isn't currently a known mechanism, or even a theory of a mechanism for it, I have no problem assuming that there is a causal relationship between the two. Of course I am familiar with the concept of relative risk, or to put it another way, only the very naive or extremely inexperienced assume that any entity contains only positives (and no negatives). Thus I have no problem taking on a 1 in 100,000 risk of a serious condition to dramatically lower my risk for another illness that KILLED 1,000 in 100,000 and caused long Covid in 30,000 in 100,000.

I appreciate your thoughtful approach to the complex issue of vaccine side effects, particularly concerning the AstraZeneca vaccine and VITT. Your consideration of the relative risks, acknowledging the potential for both positive and negative outcomes from any medical intervention, shows a balanced understanding of health and medicine.

As a clinician, I've encountered numerous accounts of various ailments following COVID-19 vaccinations. It's crucial to note that while many individuals report new or worsening symptoms post-vaccination, rigorous and controlled research into these claims is still lacking. This gap in data makes it challenging to definitively attribute these symptoms directly to the vaccine.

Should we accept these claims just because they are widespread? Or should we consider the possibility that this could be a manifestation of heightened awareness of symptoms—symptoms that may have pre-existed but were unnoticed before the pandemic? It's a complex situation where the 'bandwagon effect' could lead to over-attribution of common ailments to the vaccine. What are your thoughts on navigating these ambiguous scenarios in clinical practice and public health communication?

[LuckyR]

I appreciate your thoughtful approach to the complex issue of vaccine side effects, particularly concerning the AstraZeneca vaccine and VITT. Your consideration of the relative risks, acknowledging the potential for both positive and negative outcomes from any medical intervention, shows a balanced understanding of health and medicine.

As a clinician, I've encountered numerous accounts of various ailments following COVID-19 vaccinations. It's crucial to note that while many individuals report new or worsening symptoms post-vaccination, rigorous and controlled research into these claims is still lacking. This gap in data makes it challenging to definitively attribute these symptoms directly to the vaccine.

Should we accept these claims just because they are widespread? Or should we consider the possibility that this could be a manifestation of heightened awareness of symptoms—symptoms that may have pre-existed but were unnoticed before the pandemic? It's a complex situation where the 'bandwagon effect' could lead to over-attribution of common ailments to the vaccine. What are your thoughts on navigating these ambiguous scenarios in clinical practice and public health communication?

I will add a third commentary: "when making personal health decisions".

As to clinical practice, I had two rules. Always be on the side of your patient and minimize your exposure to personal legal risk. A perfect example of was when a large, famous (and poorly designed) study showed an increased risk of several health outcomes with postmenopausal use of systemic estrogen. At the time ERT was almost universally given. Almost overnight no one would write for it. However I had many patients who felt they benefitted greatly from it and asked to stay on it if I was willing to write for it (since almost no one would). So in those cases I had long, comprehensive discussions outlining the data as well as the shortcomings of the studies and numerous women decided to continue. I wrote for the hormones and I documented the discussion and neither they, nor I ever had a negative outcome, medically or legally.

Public health communication is much less personal, of course. So in my experience how statistical data is presented makes all the difference. For example if entity X changes risk of bad outcome Y from 1 in 100,000 to 10 in 100,000, most lay persons would be scared if you said: "X increases your risk of Y by 1000%". OTOH ten in a one hundred thousand chance doesn't sound scary. Better yet it can be equated to something understandable, say being killed by a car while walking in a year.


As to personal health decisions, I assess whether I am at higher or lower risk for the problem than average and compare it to the risk of the solution. I know that I am not the sort of personality that will second guess myself if I am the unlucky one who gets the problem.

[Sushan]

I appreciate your thoughtful approach to the complex issue of vaccine side effects, particularly concerning the AstraZeneca vaccine and VITT. Your consideration of the relative risks, acknowledging the potential for both positive and negative outcomes from any medical intervention, shows a balanced understanding of health and medicine.

As a clinician, I've encountered numerous accounts of various ailments following COVID-19 vaccinations. It's crucial to note that while many individuals report new or worsening symptoms post-vaccination, rigorous and controlled research into these claims is still lacking. This gap in data makes it challenging to definitively attribute these symptoms directly to the vaccine.

Should we accept these claims just because they are widespread? Or should we consider the possibility that this could be a manifestation of heightened awareness of symptoms—symptoms that may have pre-existed but were unnoticed before the pandemic? It's a complex situation where the 'bandwagon effect' could lead to over-attribution of common ailments to the vaccine. What are your thoughts on navigating these ambiguous scenarios in clinical practice and public health communication?

I will add a third commentary: "when making personal health decisions".

As to clinical practice, I had two rules. Always be on the side of your patient and minimize your exposure to personal legal risk. A perfect example of was when a large, famous (and poorly designed) study showed an increased risk of several health outcomes with postmenopausal use of systemic estrogen. At the time ERT was almost universally given. Almost overnight no one would write for it. However I had many patients who felt they benefitted greatly from it and asked to stay on it if I was willing to write for it (since almost no one would). So in those cases I had long, comprehensive discussions outlining the data as well as the shortcomings of the studies and numerous women decided to continue. I wrote for the hormones and I documented the discussion and neither they, nor I ever had a negative outcome, medically or legally.

Public health communication is much less personal, of course. So in my experience how statistical data is presented makes all the difference. For example if entity X changes risk of bad outcome Y from 1 in 100,000 to 10 in 100,000, most lay persons would be scared if you said: "X increases your risk of Y by 1000%". OTOH ten in a one hundred thousand chance doesn't sound scary. Better yet it can be equated to something understandable, say being killed by a car while walking in a year.


As to personal health decisions, I assess whether I am at higher or lower risk for the problem than average and compare it to the risk of the solution. I know that I am not the sort of personality that will second guess myself if I am the unlucky one who gets the problem.

I appreciate your emphasis on patient-centered care and the nuanced approach to public health communication. In my own clinical experience, I've seen similar situations where established research does not necessarily align with the empirical experiences of patients. For instance, although steam inhalation was once criticized by research for lacking benefits, in practice, many patients have praised its effectiveness. This discrepancy highlights the importance of clinician judgment alongside scientific evidence.

Continuing with your point on communication, the way we present statistical data to patients can significantly impact their understanding and decision-making. Even for us clinicians, interpreting and conveying these statistics effectively can be challenging. It's crucial that we make this information as relatable and understandable as possible, perhaps by comparing statistical risks to more familiar scenarios, as you've mentioned.

How do you think we can further bridge the gap between clinical evidence and patient experience to guide better healthcare decisions?

[LuckyR]

I appreciate your emphasis on patient-centered care and the nuanced approach to public health communication. In my own clinical experience, I've seen similar situations where established research does not necessarily align with the empirical experiences of patients. For instance, although steam inhalation was once criticized by research for lacking benefits, in practice, many patients have praised its effectiveness. This discrepancy highlights the importance of clinician judgment alongside scientific evidence.

Continuing with your point on communication, the way we present statistical data to patients can significantly impact their understanding and decision-making. Even for us clinicians, interpreting and conveying these statistics effectively can be challenging. It's crucial that we make this information as relatable and understandable as possible, perhaps by comparing statistical risks to more familiar scenarios, as you've mentioned.

How do you think we can further bridge the gap between clinical evidence and patient experience to guide better healthcare decisions?

Most clinicians decide on an optimal plan after a thorough assessment. On occasion they're left a choice with A being optimal if you want to avoid X and B is optimal if you want to avoid Y.

Then the "art" of medicine is making a presentation that explains how you came to that conclusion. If your "argument" isn't convincing to the patient, verify that if they choose what you consider to be the suboptimal option, they're okay with this or that risk or side effect (and document the conversation). Then you've tried your best, that's all you can do.

[Sushan]

I appreciate your emphasis on patient-centered care and the nuanced approach to public health communication. In my own clinical experience, I've seen similar situations where established research does not necessarily align with the empirical experiences of patients. For instance, although steam inhalation was once criticized by research for lacking benefits, in practice, many patients have praised its effectiveness. This discrepancy highlights the importance of clinician judgment alongside scientific evidence.

Continuing with your point on communication, the way we present statistical data to patients can significantly impact their understanding and decision-making. Even for us clinicians, interpreting and conveying these statistics effectively can be challenging. It's crucial that we make this information as relatable and understandable as possible, perhaps by comparing statistical risks to more familiar scenarios, as you've mentioned.

How do you think we can further bridge the gap between clinical evidence and patient experience to guide better healthcare decisions?

Most clinicians decide on an optimal plan after a thorough assessment. On occasion they're left a choice with A being optimal if you want to avoid X and B is optimal if you want to avoid Y.

Then the "art" of medicine is making a presentation that explains how you came to that conclusion. If your "argument" isn't convincing to the patient, verify that if they choose what you consider to be the suboptimal option, they're okay with this or that risk or side effect (and document the conversation). Then you've tried your best, that's all you can do.

What you have suggested here ideally makes sense. The thorough assessment and presenting choices with an explanation are fundamental in patient-centered care. This approach allows the patient to participate actively in their healthcare decisions, which is integral in fostering trust and satisfaction.

However, in clinical practice, the reality is often more complex. For instance, sometimes the conditions are severe, and the feasible options aren't well-proven for success. Additionally, the diagnosis can be uncertain, leading us to rely on empirical treatments rather than well-outlined standards. This can make it challenging to present clear choices to patients.

Patients also come with their own beliefs and expectations which can influence their decision-making process. Navigating these personal biases while trying to provide professional advice is another layer of complexity.

Moreover, a significant constraint we often face in our setup (thanks to free health) is the lack of time and resources. With the high volume of patients and limited resources, it's challenging to provide the kind of detailed explanation and engagement that would be ideal.

In light of these challenges, it’s essential to strive for a balance where we do our best to inform and involve patients within the constraints we face. Effective communication and documentation are key, but adapting our strategies to the realities of clinical practice is equally crucial. How do you think we can better manage these constraints while still aiming to provide patient-centered care?

[LuckyR]

I appreciate your emphasis on patient-centered care and the nuanced approach to public health communication. In my own clinical experience, I've seen similar situations where established research does not necessarily align with the empirical experiences of patients. For instance, although steam inhalation was once criticized by research for lacking benefits, in practice, many patients have praised its effectiveness. This discrepancy highlights the importance of clinician judgment alongside scientific evidence.

Continuing with your point on communication, the way we present statistical data to patients can significantly impact their understanding and decision-making. Even for us clinicians, interpreting and conveying these statistics effectively can be challenging. It's crucial that we make this information as relatable and understandable as possible, perhaps by comparing statistical risks to more familiar scenarios, as you've mentioned.

How do you think we can further bridge the gap between clinical evidence and patient experience to guide better healthcare decisions?

Most clinicians decide on an optimal plan after a thorough assessment. On occasion they're left a choice with A being optimal if you want to avoid X and B is optimal if you want to avoid Y.

Then the "art" of medicine is making a presentation that explains how you came to that conclusion. If your "argument" isn't convincing to the patient, verify that if they choose what you consider to be the suboptimal option, they're okay with this or that risk or side effect (and document the conversation). Then you've tried your best, that's all you can do.

What you have suggested here ideally makes sense. The thorough assessment and presenting choices with an explanation are fundamental in patient-centered care. This approach allows the patient to participate actively in their healthcare decisions, which is integral in fostering trust and satisfaction.

However, in clinical practice, the reality is often more complex. For instance, sometimes the conditions are severe, and the feasible options aren't well-proven for success. Additionally, the diagnosis can be uncertain, leading us to rely on empirical treatments rather than well-outlined standards. This can make it challenging to present clear choices to patients.

Patients also come with their own beliefs and expectations which can influence their decision-making process. Navigating these personal biases while trying to provide professional advice is another layer of complexity.

Moreover, a significant constraint we often face in our setup (thanks to free health) is the lack of time and resources. With the high volume of patients and limited resources, it's challenging to provide the kind of detailed explanation and engagement that would be ideal.

In light of these challenges, it’s essential to strive for a balance where we do our best to inform and involve patients within the constraints we face. Effective communication and documentation are key, but adapting our strategies to the realities of clinical practice is equally crucial. How do you think we can better manage these constraints while still aiming to provide patient-centered care?

Oh, I reconciled the "too little time" issue very, very early in my career. I took as much time as I needed to do the amount of work that I felt I needed to provide. Which is a fancy way of saying I ran late. Basically the way I see it, you have two choices: give folks the bum's rush and be on time, or give them the time they need and run late. I ran late. BUT, in my experience, folks don't mind being seen late IF, when they get their turn, all of their needs are met. You absolutely can't run late THEN give someone the bum's rush (to "catch up"). That's a disaster. I figure a reasonably savvy person will figure out why they were seen late, when their appointment lasts longer than the allotted time.

[Sushan]

I appreciate your emphasis on patient-centered care and the nuanced approach to public health communication. In my own clinical experience, I've seen similar situations where established research does not necessarily align with the empirical experiences of patients. For instance, although steam inhalation was once criticized by research for lacking benefits, in practice, many patients have praised its effectiveness. This discrepancy highlights the importance of clinician judgment alongside scientific evidence.

Continuing with your point on communication, the way we present statistical data to patients can significantly impact their understanding and decision-making. Even for us clinicians, interpreting and conveying these statistics effectively can be challenging. It's crucial that we make this information as relatable and understandable as possible, perhaps by comparing statistical risks to more familiar scenarios, as you've mentioned.

How do you think we can further bridge the gap between clinical evidence and patient experience to guide better healthcare decisions?

Most clinicians decide on an optimal plan after a thorough assessment. On occasion they're left a choice with A being optimal if you want to avoid X and B is optimal if you want to avoid Y.

Then the "art" of medicine is making a presentation that explains how you came to that conclusion. If your "argument" isn't convincing to the patient, verify that if they choose what you consider to be the suboptimal option, they're okay with this or that risk or side effect (and document the conversation). Then you've tried your best, that's all you can do.

What you have suggested here ideally makes sense. The thorough assessment and presenting choices with an explanation are fundamental in patient-centered care. This approach allows the patient to participate actively in their healthcare decisions, which is integral in fostering trust and satisfaction.

However, in clinical practice, the reality is often more complex. For instance, sometimes the conditions are severe, and the feasible options aren't well-proven for success. Additionally, the diagnosis can be uncertain, leading us to rely on empirical treatments rather than well-outlined standards. This can make it challenging to present clear choices to patients.

Patients also come with their own beliefs and expectations which can influence their decision-making process. Navigating these personal biases while trying to provide professional advice is another layer of complexity.

Moreover, a significant constraint we often face in our setup (thanks to free health) is the lack of time and resources. With the high volume of patients and limited resources, it's challenging to provide the kind of detailed explanation and engagement that would be ideal.

In light of these challenges, it’s essential to strive for a balance where we do our best to inform and involve patients within the constraints we face. Effective communication and documentation are key, but adapting our strategies to the realities of clinical practice is equally crucial. How do you think we can better manage these constraints while still aiming to provide patient-centered care?

Oh, I reconciled the "too little time" issue very, very early in my career. I took as much time as I needed to do the amount of work that I felt I needed to provide. Which is a fancy way of saying I ran late. Basically the way I see it, you have two choices: give folks the bum's rush and be on time, or give them the time they need and run late. I ran late. BUT, in my experience, folks don't mind being seen late IF, when they get their turn, all of their needs are met. You absolutely can't run late THEN give someone the bum's rush (to "catch up"). That's a disaster. I figure a reasonably savvy person will figure out why they were seen late, when their appointment lasts longer than the allotted time.

You definitely have a point about the value of taking time to provide thorough care to patients. In my own practice, I've noticed that patients really appreciate it when they feel heard and cared for, especially when we take the time to address all their concerns. This approach, as you mentioned, does indeed lead to running late, but the trade-off can be worthwhile in terms of patient satisfaction and quality of care.

However, the challenge arises when dealing with long queues and a high volume of patients (a common scenario in our practice). In such scenarios, spending extended time with each patient can exacerbate wait times for others, leading to extended shifts and added strain on other staff members like nurses, pharmacists, and lab technicians, etc. This can contribute to overall fatigue among healthcare providers, which might inadvertently compromise the quality of care towards the end of the day. (I have personally experienced this)

How can we maintain a balance between providing thorough, attentive care and managing our time effectively to minimize the impact on waiting patients and other healthcare staff? Perhaps there are systemic or procedural changes that could support this balance. What are your thoughts on this, or what strategies have you seen work in similar situations?