There are only 3 untruths in life; Lies, damn lies and statistics.
The phrase above was taken from a book that I've read, title I cannot remember. I think it's from one of Dean Koontz' novels but I am sure it was from a bookseller.
The phrase above was attributed to Benjamin Disraeli by Mark Twain. And I read it from Michael Palmer's New York Times Bestseller Miracle Cure.
I know many people would interpret this line differently. For me it's really a garble line. I acquired this line for ages already, meandering for truths behind these 3 untruths, yet apparently I cannot really unfold. I don't even know what's the difference between damn lies and just plain lies. Do you? Pft! However, I think I realized it's true meaning already just now; the truth behind that particular line.
It's probably just a correlation to what had happened in Surgery class a few days ago but anyway, I now understand why Mark Twain referred to statistics as an untruth.
In med school, a lot of people believe in statistics. We rely on diagnostic tools and treatment modalities that has been nicely evaluated statistically. But why do we need to rely on these numbers?
Let's say smoking is a high risk for developing lung malignancies. Also, smoking is a risk factor to the development of esophageal malignancies. Why do we need statistics?
Smoking has a lot of adverse effects. If I have to list all these effects in this entry then I'll probably consume the whole page of my blog, and you would probably stop reading because it would be sooooo boring.
When we do history taking from patients we ask them their personal and social histories like smoking, drinking, use of drugs and sexual practices. If you are a smoker then there are a lot of diseases that may actually result as a smoker; cancer in almost all your body parts, ulcers, lung problems, heart problems, vascular problems and so on and so fort.
So why is it really important to ask if in actuality smoking is really a risk to all diseases?
I diagnosed a patient presenting with dysphagia (a patient who cannot or have difficulty swallowing) as having an esophageal carcinoma (cancer of the esophagus) basing it from his history and physical examination. I included his smoking as a feature for the development of cancer. My facilitator didn't agree.
I told him I read it in the book that smoking is a risk factor.
He told me smoking is a risk factor to everything.
So why should I care? Or why would I include it in as an important feature?
I am really convinced that it's really a malignancy of the esophagus but his was different. He said I should think of a more common disease entity. Like what?
I didn't get his point.
Should we depend on statistics regarding our decisions on diagnosing a patient? For the past cases we've discussed exclusively within a small group, my impressions were all abolished by our facilitators. I observed that the real reason behind the quashing of my diagnoses was statistics.
Their impressions more often than not rely more on statistics. A more common disease entity will usually be the impression to our cases. Why is it so? Is it impossible for the patient to acquire certain rare disorders? Or rather the 3rd or even the 4th most common?
In case analysis, what's written in the patient's data and history and PE will be the only basis for the diagnosis. Isn't it more appropriate to consider all the salient features in making an impression? I know that the more common disease entities should be considered too. Is statistics blinding us from all the other possibilities?
Exactly! I think statistics are blinding a lot of people into a lot of certain things. People aren't open to other possibilities because they rely too much on statistics.
I also noticed that when I read med books, there are statements like...
One study shows that...
...therefore it may contribute to the patient's current signs and symptoms.
Did you notice a questionable part of the phrase?
Use of the word "MAY" is always apparent when it's supported by studies and/or statistical data are presented in journals and books.
MAY is used in expressing a wish or hope. It's not a fact or it will never be a fact. It's just MAY. It can or cannot.
I am not abolishing statistics here, but aren't we supposed to focus first to the patient before we rely on statistics?
Picture was taken from HERE!