The well-known medical specialist and educator have recently given a talk at an online lecture organized by ITMO’s Science Communication Center for students.
ITMO.NEWS met with Olga Zhogoleva to learn more about evidence-based medicine in Russia, the importance of medical communication, and the ways to build it.
“Often patients aren’t ready to change their beliefs. For doctors, it’s even harder”
In your lecture, you talked about how evidence-based medicine works in Russia and why medical communication is needed. Why is it especially important to talk about this today?
This is my favorite question that I had to discuss even with my patients to tell them the roots of a famous post-Soviet saying – Many men, many minds.
In general, evidence-based medicine is not a completely correct term. It would be better to say “medicine based on evidence that is ranked according to its value. This method allows a medical specialist and an educated patient to make decisions based on the efficiency and safety of a particular treatment. Unfortunately, now the term evidence-based medicine in Russia is losing its reputation as it is always opposed to not-evidence-based one.
It sounds absurd because it is just another development stage. Medicine has always been evidence-based. But until the second half of the 20th century, people believed in authorities that doctors referred to. That is, we used this or that treatment because that is what some professor from Oxford or Munich did. In the USSR, people also focused on the opinions of professors, department heads, and supervisors. I think that we are still there, even now.
Such opinion-based medicine did not exclude the human factor and evidence-based medicine came down to the fact that it should be excluded. Therefore, evidence-based medicine is not about “proven” or “not proven” but about the quality of our data.
As people, we do not understand the nature of evidence-based medicine and it is essential to explain it to the public – to patients, doctors, and all interested. They need to know what evidence-based medicine is about, why it is important to trust science and not traditions or professor’s opinions. And also, we should not allow evidence-based medicine to become a label that doctors would simply use because they do not prescribe immunomodulators and other useless drugs.
I would like doctors and journalists to bring this truth to the public. Thus, we will finally get rid of the many men, many minds saying.
But attention to the evidence of treatment’s efficiency did not appear for no reason. We all know about drugs that are prescribed and sold without proper research. Moreover, we have all heard stories about weird doctor’s prescriptions – the other day my friend was prescribed holy water from Tikhvin for pyelonephritis.
Speaking of your example, we can say that a human factor is a real thing in any field. And we pay even more attention to it when it comes to our health, as it can cause more harm.
As for the problem, it seems to me that the radical approach causes more resistance. Often patients are not ready to change their beliefs. For doctors, it is even harder. Just imagine a psychological effort doctors need to make in order to admit that everything they used to do was wrong and tomorrow they need to work in a new way.
Therefore, I can understand those who are eager to defend evidence-based medicine, but in my opinion, explaining works better. That’s how we create an audience that understands what we are talking about. Over the past five years, the number of educated patients has increased.
You say that now more people understand evidence-based medicine. Can we talk about the shift in favor of evidence-based medicine, as well as about improving communication between doctors and patients?
I went to university in Voronezh and now this university has become one of the strongholds of modern medicine in Russia thanks to the efforts of the neplacebo community. However, when I was studying there (I graduated in 2007), all these popular double-blind placebo-controlled studies were explained to us as something great, but also very difficult to achieve.
The models of doctor-patient interaction differ around the world. In Cambridge, for example, doctors have been studying the science of communicating with patients for years. We’ve studied it for a few weeks in medical bioethics. In our case, the model of paternalistic communication, when the doctor is in charge and the patient simply obeys, is considered the right one. It leads to the fact that even modern doctors who are just ten years older than me and follow all principles of evidence-based medicine in their practice still believe that Russian patients are special and need to be patronized.
I think that there is such a stubborn part of our brain that resists change. Probably, all this will stay with us much longer than opinion-based medicine. Simply because we were taught this way, and we need to make an effort to change our strategy.
And yet the changes seem enormous to me. At least we started to discuss a partnership with the patient. Earlier, when I started work, it was seen as familiarity. Now we are talking about this and it is one of the values that we learn from others when we have access to English-language information and read studies devoted, among other things, to the patient's life quality and ethics.
However, it is believed that only ten percent of doctors can read international medical literature in English. The rest have no access to this information in order to find out that the whole world works differently and does so because it is more effective and safer for the patient. This is a huge problem. And only when we will differ our reality, universities will teach us how to find information on our own, read English-language literature, evaluate the quality of research – then we will change the situation dramatically.
About medical communication
You are talking about the role of health education. What about medical communication in our country?
As an enthusiastic person, I am happy that it simply exists. The advent of medical journalism made it easier for us. When we all say that modern medicine is trying to be safer, explain how everything works, what research doctors draw on, then patients start to trust it more.
On the other hand, sadly, not all journalists are ready to reach the level set by Daria Sargsyan and Namochi Mantu. Some journalists are convinced that it is enough to expose a few myths. This is an indicator of the quality of the content, although people are driven by completely philanthropic motives – they want to explain what we all have been wrong about.
I would like medical journalism to set a high bar for itself when creating content and attract experts not just for remarks, but also for reviewing. The medical journalist acts partly as a doctor, explaining what to do and what not to do. And here, too, you can bring harm by telling a patient too harshly that everything they did before was stupid.
Then terrified patients come to a doctor and say that they have read such and such on the Internet and that everything they suggested was bad. It is even worse if they were treated correctly but because of some online information started to use things like coffee enemas. I had a patient who cried at my appointment because, on the one hand, she liked the way I treated her, but on the other hand, she was disappointed that I refused to admit that the Epstein-Barr virus was destroying her body, as she read on the Internet. There are many such stories.
Therefore, I am all for modern journalism developing and moving forward. The main thing is to establish rules and remember that people read it. Moreover, often sick people, whose mental state is already fragile, read about diseases, and they are a little more trusting, because they really want to get well and will do anything for this. Therefore, medical content must be checked and verified ten times.
But doctors are not always ready to communicate with journalists either
Well, I am talking now about medical journalists not because they are to blame for everything, but because this is the topic of our conversation. We are all equally involved in creating both the good and the negative image of modern medicine. It is the fault of both doctors and those connected with education. Also, the way a doctor's work is organized does not help the situation. They usually have 12 minutes to examine a patient, diagnose, explain everything, show sympathy, and clarify all fears – and it’s not enough.
Also, you waste a lot of time doing paperwork and it can cause burnout. If we add to this the not very good image of a doctor with low credibility that the media created, we can see how it all leads to burnout, unwillingness to grow and move forward. This is terrible!
I'm not saying that everyone is like that: only a few are so burned out that they do nothing the whole day, but it happens. Therefore, when we say that doctors refuse to give interviews, it is not because they treat journalists with contempt but because they are tired – and it is chronical.
Also, not everyone has the ability to express their thoughts clearly, to talk about their specialization so that others would understand. Not everyone is able to explain even to patients, although this is their duty, and speaking to a journalist is goodwill. We all need to cooperate and that's why we all met at this lecture and have this talk. We all want to do a good job.
Today's COVID-19 situation has given a completely different sound to scientific and medical news. Doctors are constantly on the screen, medical articles are at the top of the news. Does this somehow change the attitude towards medicine and medical journalism?
This clearly has a positive impact on people’s perception of medicine. I can say that publications from medical journalists attract the attention of those who are not frequent visitors to doctors.
Many, coming to the doctor, already conduct a meaningful dialogue: perfect patients know what to tell about their complaints and what questions to ask in order to understand whether this treatment and this therapist is right for them. This is all due to medical journalism. Now it is important not to lose it, so that, hiding behind the title of a medical journalist, people generating low-quality content would not flood the Internet.
Why do we need medical blogs?
Today you have over 160,000 Instagram followers. Why did you start a blog about evidence-based medicine in the first place?
I must say that when the blog appeared, it was less evidence-based (laughs). I am a chatty person, at my appointments, too. I always tried to explain to patients what was happening to them and how they would be treated. At some point, I realized that I was saying the same thing all the time and I thought that if I can present it out to a wider audience, then people will come more prepared.
And that's how it all began. It is noteworthy that many doctors who run blogs not only write posts for them but also have to educate themselves all the time. If you want to write something, then you need to at least refresh your knowledge, or even better – start over and understand where you were wrong before. So, gradually, my Instagram came into the fold of the Holy Evidence-Based Medicine (laughs). Now I try not to deviate from these rules, not to share my speculations with the public, or at least not to replace reasonable data with them.
No matter how hard I tried to convey to the readers that there is a reference behind each word, that I can argue for any fragment of my publications, all the same, there are always questions in the comments: “What is your attitude?”, “What do you think?”. People don't really understand where personal opinion ends and general medical knowledge begins. For readers, both my guesses and the references to qualitative research are the same – this imposes a huge responsibility, so I add information to my blog very slowly.
When we talk about the difficulties of evidence-based medicine in Russia, allergology is not mentioned among the first “problematic” areas. How widespread are myths in this science?
Allergology in our country is full of myths. Moreover, since the allergy appears early in childhood with first food, these myths leave an imprint on the life of the whole family – a child, a nursing mother, everyone. Thanks to these myths, the diet of a child under five or six years old is sometimes reduced to three products – buckwheat, turkey, and zucchini. The child might be on a diet like this for several years.
What are the most popular myths?
The myth about red being a terrible allergen. If you approach a person on a street and ask what is the most allergenic, they will say sweet, citrus fruits, chocolate, as well as everything red and orange. But it is actually milk, eggs, wheat, fish, nuts, and soy. Do you understand how different people's opinions and reality are?
Another thing is not so much a myth, but rather outdated practice. For a long time, it was believed that if people were diagnosed with an allergy, then it was necessary to protect them from all potential allergens. Today, science adheres to a completely opposite view, recommending those who are at risk, to get acquainted with the maximum number of allergens as soon as possible, not to limit contact with animals, so that the immune system does not work in an allergic manner.
Here is another story from practical allergology. There is such a thing as anaphylaxis – a generalized allergic condition portrayed in movies like this – a person eats a nut, loses consciousness, and starts to choke. The only correct way to provide first aid here is to inject adrenaline.
But the public and even some medical specialists associate it with Pulp Fiction and the injection of the heroine for Uma Thurman. Everyone expects terrible heart problems. We still do not have auto-injectors, special syringes that automatically, when they hit the surface, inject even through clothing. It really saves lives, it is all over the world, but we do not have it yet.
There are also myths about non-allergenic animals; they are said to have hair instead of wool, so they do not cause a reaction. It is not true. There are also legends that when a woman is breastfeeding, she must follow a white-green diet, avoid drinking milk. And she should not eat anything at all just in case. But actually, pediatricians recommend drinking milk and eating both fruits and vegetables. Such recommendations greatly affect the life of the whole family.
How helpful blogs like yours are for other doctors?
Of course, they are helpful – this is how we find each other. You can see what a person believes in and how they respond when asked for proof on their accounts. Sometimes people meet each other, become friends, and create medical centers together.
However, it frightens me that specialists need such blogs even in their own fields. I see something similar when I communicate with colleagues: I suggested an article for them to read and they told me that it was not necessary and asked me to tell them in a nutshell.
So, thanks to blogs, we find new connections, as well as create joint projects and conferences that help us meet each other. But on the other hand, it is alarming that instead of searching for information, some doctors read medical blogs and believe that they now know everything.