Questões de Vestibular

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The challenge of doctor-patient relations in the internet age

     “Let me do some research and I’ll get back to you,” my patient said. My patient, a 19-year-old student, had already taken time off from school because of her anxiety. I was her psychiatrist, with over two decades of experience treating university students, and had just explained my diagnostic impressions based on a lengthy evaluation. I’d recommended that she try a medicine I expected would help. I’d also laid out the risks and benefits of other treatment options. 

      “Do you have additional questions I can answer?” I asked. I wanted to let her know that’s why I was there, to cull the research, to help make sense of it. “No, I like to go online and look for myself,” she said.

     More and more, I see students turning away from the expertise that a live person can offer and instead turning to the vast and somehow more objective-seeming “expertise” of the digital world.

     In an age when journalism we don’t like can be dismissed as “fake news,” suggesting that the information we do like is most credible, regardless of its source, it’s not hard to understand why young people do this. The medical profession itself, under managed care, has played a role as well, providing less time for doctor-patient interactions and undermining the chances that a personal relationship and trust can develop. Under the guise of efficiency, medical test results are now often released directly to patients, sometimes before or even without the benefit of any interpretation.

     But there’s danger in trusting data over people, as there is in thinking the expertise of all people is equivalent. When it comes to health, digital natives may not be learning how to navigate effectively. And the consequences could be harmful.

    The availability of health data on the internet has its benefits. Online, for example, we can find explanations and solutions for symptoms we might be too embarrassed, or afraid, to discuss with another person, in person. Or, for lifethreatening diseases, we can locate clinical trials our doctors may not be aware of.

     However, there’s also a lot of misleading information, and information that’s simply untrue. The internet is full of people selling things – supplements, treatment regimens that have not been rigorously tested, even prescription medications – and making false promises that have not been scrutinized by regulatory agencies. Sometimes, as in the case of some websites that promote “an anorexic diet” for “aggressive” weight loss, the information can encourage life-threatening behavior.

      Years ago, when we discussed paternalism versus patient autonomy in my medical school ethics class, I came down strongly in favor of autonomy. Who but the patient could best decide what was right for him or her? But years of clinical – and personal – experience have taught me that information in and of itself is insufficient. Judgment is also indispensable, especially in complex situations, and the capacity for good judgment rests within people, not data sets.

(Doris Iarovici is a psychiatrist at Harvard University’s Counseling and

Mental Health Services and the author of Mental Health Issues and the

University Student. www.nytimes.com, 01.03.2018. Adaptado.)

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The aliens among us

     Humans think of themselves as the world’s apex predators. Hence the silence of sabre-tooth tigers, the absence of moas from New Zealand and the long list of endangered megafauna. But sars-cov-2 shows how people can also end up as prey. Viruses have caused a litany of modern pandemics, from Covid-19, to hiv/aids to the influenza outbreak in 1918-20, which killed many more people than the first world war. Before that, the colonisation of the Americas by Europeans was abetted – and perhaps made possible – by epidemics of smallpox, measles and influenza brought unwittingly by the invaders, which annihilated many of the original inhabitants.

(www.economist.com, 22.08.2020. Adapted.)

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Avoiding meat and dairy is single biggest

way to reduce your impact on Earth 

    Avoiding meat and dairy products is the single biggest way to reduce your environmental impact on the planet, according to the scientists behind the most comprehensive analysis to date of the damage farming does to the planet.

      The new research, published in the journal Science, shows that without meat and dairy consumption, global farmland use could be reduced by more than 75% – an area equivalent to the US, China, European Union and Australia combined – and still feed the world. Loss of wild areas to cattle farming is the leading cause of the current mass extinction of wildlife.

     The new analysis shows that while meat and dairy products provide just 18% of calories and 37% of protein, they use the vast majority – 83% – of farmland and produce 60% of farming greenhouse gas emissions. Other recent research shows 86% of all land mammals are now livestock or humans. The scientists also found that even the lowest impact by meat and dairy products may cause much more environmental harm than the least sustainable vegetable and cereal growing.

(Damian Carrington. www.theguardian.com, 31.05.2018. Adaptado.)