Information is not Enough: The Place of Statistics in the Doctor-Patient Relationship

  • Kathryn Montgomery
Part of the Cancer Treatment and Research book series (CTAR, volume 140)


The hero of Leo Tolstoy’s The Death of Ivan Ilych is a man of “incorruptible honesty,” who prides himself on his work as an examining magistrate:

Ivan Ilych never abused his power; he tried on the contrary to soften its expression, but the consciousness of it and of the possibility of softening its effect supplied the chief interest and attraction of his office. In his work itself...he very soon acquired a method of eliminating all considerations irrelevant to the legal aspect of the case, and reducing even the most complicated case to a form in which it would be presented on paper only in its externals, completely excluding his personal opinion of the matter, while above all observing every prescribed formality.1


Sick People Prescribe Formality Official Relation Chief Interest Scientific Answer 
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References and Notes

  1. 1.
    Leo Tolstoy, “The Death of Ivan Ilych,” [1886] translated by Aylmer Maude in The Death of Ivan Ilych and Other Stones. New York: Signet, p. 107.Google Scholar
  2. 2.
    Tolstoy, pp. 117-188.Google Scholar
  3. 3.
    Tolstoy, p. 121.Google Scholar
  4. 4.
    Tolstoy, p. 122.Google Scholar
  5. 5.
    Peter Angelos, “Patterns of Physician-Patient Communication: Results of Preliminary Studies,” presented to a symposium in honor of David L. Nahrwold, Northwestern University Medical School, 27 February 1998.Google Scholar
  6. 6.
    Kerrigan DD, Thevasagayam RS, Woods TO, et al. Who’s afraid of informed consent? Brit Med J 1993;306:298–300.PubMedCrossRefGoogle Scholar
  7. 7.
    Howard Brody, however, has made it the core of the conversational ethics he describes as essential to primary care and highly useful in sub-specialty medicine; see The Healer’s Power (New Haven: Yale University Press, 1992).Google Scholar
  8. 8.
    The phrase has been in use for more than a decade, but there is no better illustration of it than Reynolds Price’s account of being told his diagnosis, tout court, in a busy hallway of the Duke University Hospital by two young specialists who then turned and rushed off to other, more important duties: A Whole New Life: An Illness and A Healing (New York: Penguin/Plume, 1994).Google Scholar
  9. 9.
    Kahneman D, Tversky A. The framing of decisions and the psychology of choice. Science 1981;211:453–58. See also their earlier Judgment under uncertainty. Science 1974;185: 1124-31.PubMedCrossRefGoogle Scholar
  10. 10.
    Bogardus ST, Holmboe E, Jekel JF. Perils, pitfalls, and possibilities in talking about medical risk. JAMA 1999;281:1037–41.PubMedCrossRefGoogle Scholar
  11. 11.
    Stettin D. Coping with blindness. NEJM 1981; 305: 458–60.CrossRefGoogle Scholar
  12. 12.
    Philosophers and sociologists of science have long described science as more contextual and socially constructed, but when it comes to medicine, physicians and the general public still subscribe to the now out-dated Newtonian, positivist view.Google Scholar
  13. 13.
    Aristotle, Nicomachean Ethics II 2, 1104a7.Google Scholar
  14. 14.
    Branch WT, Suchman A. Meaningful experiences in medicine. Amer J Med 1990;88: 56–59.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media New York 2000

Authors and Affiliations

  • Kathryn Montgomery

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