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Chapter 1: What is the main topic discussed in this episode?
Future Proof Extra with Jonathan McRae. Proudly supported by Research Ireland on Newstalk.
Now, this is a true story. About 12 hours ago, I banged my head at a game of football against a side railing and blood was gushing into my hands. It was quite a scary experience. And I went into the reception of the sports facility and they gave me some bandages and my hands were covered in blood. I was quite scared. And I put my hand over and held the wound closed.
Chapter 2: What personal experience highlights flaws in the healthcare system?
Until paramedics came and paramedics came and they said, look, it's not too bad. And they said, you should probably get it looked at. And I said to myself, they said, it's not too bad. I'm not waiting in A&E for eight hours. And I went home. And that in itself is a pretty damning thing. Pretty damning assessment of my experiences in A&E. And that, you know, that would happen.
You'd be advised by paramedics with a head injury to go to hospital and you as a grown man with his brain working say, no, I'm not going to do that because... I don't want to be waiting for six hours and just be sent home. That says a lot. And so while we talk on this program about the wonders of medicine and science, the system, the health system that we interact with is deeply flawed at times.
And we all know this. But how might we make it better? This is a question that Associate Professor in the Department of Women's and Children's Health at Uppsala University and Dr. Bott, Why Doctors Can Fail Us author, Charlotte Bleas, has been exploring. And she joins me now. Welcome to the program, Charlotte. Good to have you on.
Great to be on. And I'm very sorry to hear about your injury.
No, it's fine. It's fine. It's fine. I am fine. The paramedics were right. But like, it just says a lot, right? And so I wanted to ask you, because this is a really deeply researched book. It's got loads of really interesting anecdotes about how things are and why they are. But you're a philosopher as well. So it kind of looks at the ethics and the whys of things.
And I suppose I wanted to ask you, why did you write this book and what were you trying to achieve with it?
Yeah, I wrote the book because I was really interested in thinking about exactly what you've commented on and observed in your own case. What are the problems with current health systems? And as patients, we're very alert to them. We know what they are. But what are the problems to which technology could potentially be a solution.
So what I focus on is problems like what you've mentioned, access to health care. It's estimated that there was a study in the US in 2020 that found that patients take an average of two hours out of their day for a 15 minute medical appointment. And that's longer, incidentally, if you're if you're on a lower income.
because you probably have to take time off gig economy jobs and use public transport. So there's all kinds of barriers to accessing our doctors. But even whenever we get into the clinic, there are all kinds of psychological pitfalls that can kick in as well.
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Chapter 3: How does Charlotte Blease define the problems with current health systems?
But what's really interesting is the older doctors get, and we do have an ageing medical profession, about a third of doctors in Europe are over 55 years old. What that means is that they tend to be, older doctors are more confident in their decisions, but they're less likely to be accurate. Is that right? Yes, and that's because of the evidence base.
The evidence base in medicine tends to be more or less fixed at the time at which you graduate. So the greater the distance there is from your medical education, and again, that reflects the challenges of keeping up to date with medical information, you have quite serious knowledge deficits.
Wow. So the research shows that you basically are almost, when you graduate, that's sort of how you think the body works. And even though you might be doing these upskilling, generally, most doctors don't keep up with the latest developments in medicine?
They just don't have time to do it. Now, that's not sort of a blanket assumption in terms of, you know, you can keep up to date in certain ways. But across the board, you will not be able to update your entire corpus of medical knowledge to keep track of things. the evidence as it's changing and accumulating. And medical evidence does change.
There's a phenomenon known as medical reversals, meaning that the evidence for a particular therapeutic may change so that it's actually discovered not to be useful or in some cases harmful.
But surely there's some sort of bulletin or database that doctors can go, I mean, I'm assuming that happens, that you go to a doctor and you say, I've got this, and they check what the latest medicine is on this before they give you a diagnosis or treatment?
Yes. Yes, but a large part of what doctors do is instinctual as well. And when we were talking about keeping up to date, you know, in the old days, if you went to a doctor, they might have taken an encyclopedia or some sort of a medical textbook to flick through it. Nowadays, of course, they do use the Internet. They will use Google.
And clinical decision support tools, which have been designed for medical use, it should be said, those are sort of computer tools that give information that is supposed to be up to date, are very poorly used by doctors.
But surely ChatGPT has all the answers now. ChatGPT or OpenAI just released a version of the AI just for clinicians. Surely, you know, this gives them access to an enormous amount of information they can seek online. through, you know, obviously ChatGPT will make mistakes, but when it comes to medical science, it does, on the whole, a pretty good job if used by a medical professional, correct?
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Chapter 4: What role does technology play in improving healthcare access?
But if we're talking about better patient outcomes, which is what the whole healthcare thing should be... there must be benefits here beyond that as well, right? I mean, like one of the things that I feel when I go into my GP who is lovely and I trust him implicitly, but when I go in, it's a, hi, how can I help? And there's that sense of speed. I feel like I'm, holding him back.
I should, you know, and he's actually very good because he switches that off very quickly. But you do get a sense you've got a short amount of time. You better get in, get out because there are other people waiting. And that's a case in all health systems because people are busy.
They have a certain amount of time to see you and get out because they've got a certain amount of patients they need to see on that day. That leads to people not asking maybe the questions that they might not, you know, luxuriating and wanting to know a little bit more detail sometimes. And that can be problematic, right?
Yeah.
Absolutely, it is. And the way I frame it too, I take a kind of principle of charity approach because a lot of the time the healthcare professionals will say, look, we just need more money in the system. We need better working conditions. Look, I agree with all of that. But the perspective I take is, let's say we have a kind of Shangri-La of medicals
you know, throw any amount of money at them within the current system, you're still going to have these human problems. And that is partly because when you're a patient, by default, you are consulting with an expert. You're going to see a doctor who has this expertise.
And that tends to, if you look at the psychology of status, when there's somebody who's more subordinate in a certain context going to speak to somebody who's more, by default, prestigious, people tend to be more deferential. They ask fewer questions. They want to be seen in a particular light. And they also sort of engage in a lot of impression management, which is quite an exhausting enterprise.
Not quite the same thing as going on a first date, but you want to be seen well by your doctor. So that means that you might not admit to certain embarrassing or socially sensitive symptoms. Domestic violence, mental health, severe depression. People take a long time to admit these things to their doctors and they delay help seeking.
And studies in the States show that about 85% of adults have admitted lying to their doctor or at least massaging the truth. That interferes with the doctor being able to do their job too. And doctors also tend to dominate the dialogue. They don't mean to do it. But again, that does tend to happen when you have that kind of psychological setup, if you will.
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