Friday, May 15, 2009

Ultracrepidarian Doctors and Back Pain

An ultracrepidarian is a person who professes expertise the they do not posses. This is an epithet not often used but I am fond of and have used in presentations and my ethics column. Some might say that fondness is because it should be applied to me. Nevertheless, I like it because I find so many experts who pontificate on that which they know so little. Think of my earlier blog entry about Katz.

There is a classic paper that sort of tested the prevalence of this disorder amongst very smart college students. The title says it all, "Unskilled and unaware of it: How difficulties in recognizing one's own incompetence lead to inflated self-assessments". (The link goes to free full text)

A new study, published in today's Spine by Buchbinder et al could be called ultracrepidarian doctors and back pain. The paper, "Doctors With a Special Interest in Back Pain Have Poorer Knowledge About How to Treat Back Pain" details a study that surveyed general practitioners about their interest and knowledge regarding how to treat back pain. The results are counter-intuitive because those with the greatest interest in treating back pain had the poorest knowledge of the current best evidence of how to treat it. Thus, they were ultracrepidarians.

It was almost comical but the doctors with a special interest in back pain thought that guidelines are very helpful in determining how to treat patients with back pain, yet they choose treatments, such as bed rest, that are clearly bad for patients. Bed rest in particular has been known to be harmful for a long time.

This paper is very similar to one published quite a while ago also showing that doctors choose treatments that are ineffective and avoid ones that are effective such as spinal manipulation.

Buchbinder and colleagues previously published studies that showed that public education reduces disability from workers compensation type claims. Sometimes the public is teachable and their doctors aren't. I wish I could give patients hope that the doctor they go to really is up-to-date but clearly if the doctor says they are does not mean that they actually are.


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