Doctors know it is good practice to explore patients’ values and beliefs, but we sometimes forget that our views and priorities are subjective too, writes Stephen Bradley
One of the most satisfying tasks in general practice is the opportunity to guide patients through their options and work out which one best fits that individual’s values and preferences. I find this often involves gauging that patient’s own philosophy with respect to medicine and what they hope it can do for them. My approach isn’t innovative. It has been deliberately inculcated during a decade of training and is an utterly orthodox principle of contemporary medical practice. Yet sometimes I wonder if we doctors are reluctant to admit that we have values and beliefs too, which inform how we interpret the evidence and options before us.
That the tenor of disputes between doctors and scientists over the past ten months has sometimes become just as unpleasant as discourse over Trump or Brexit is one of the most troubling aspects of the coronavirus pandemic. The current climate of political polarisation has engendered nasty and destructive value disputes that often masquerade as factual debate. We seem to have lost the capacity to take account of others’ values and priorities or even to acknowledge how these inform our own positions. The result is that evidence is preferentially promoted or debunked in accordance with entrenched viewpoints in a rhetorical zero-sum game. This kind of public discourse does little to help us understand how to navigate the incredibly difficult policy tradeoffs we face.
Amid great uncertainty, rival policies have been promoted with jarring conviction, rather than the kind of reflection and nuance required to achieve some mutual understanding and collective buy-in for a way forward. Alternative perspectives are often dismissed as motivated by bad faith or worse. We have struggled to navigate the novel hazards created by social media companies that monetise discord. Playing to the online gallery seems to bring many a sense of vindication or camaraderie, but insinuating that opponents are either mugs, liars, or sociopaths is hurtful and unpersuasive.
Such polarisation also drowns out the voices of those among us who have tried to “follow the science” but still just aren’t that sure where it leads. It seems paternalistic to assume that the public need to receive a wholesome lullaby of overconfident assertion. I suspect that mature discussions, which acknowledge legitimate disagreement and promote measures as being reasonable and proportionate, given the uncertainties, would be more reassuring to many.
Along with everything else we’ve learnt during this pandemic, I hope that we can improve the quality and courtesy of our discourse. Most of us try hard to understand our patients. Trying harder to understand the values and beliefs of those we disagree with, and appreciating how our own views are also shaped in the same way, might help us to disagree better in the future.
Stephen Bradley is a GP and clinical research fellow at the University of Leeds. Twitter @DryBreadnRadio
Competing interests: I receive funding from Cancer Research UK for PhD research. I am a member of the executive committee of the Fabian Society, which is a think tank affiliated to the UK Labour Party. A full disclosure statement is available here: https://medicinehealth.leeds.ac.uk/medicine/staff/1211/dr-stephen-bradley