Misconceptions in medicine and my reflections on Heather’s challenges

Seafood allergy and iodine

A commonly held misconception in medicine is the link between seafood and/or shellfish allergy and iodine. I encounter this quite often as I am a surgeon and we use povidone-iodine as a topical antiseptic that is applied to the skin or other tissues before surgery. I’m not sure where it comes from but many physicians and nurses believe that seafood and/or shellfish allergy is a contraindication to the use of iodine. It seems to be a commonly held belief that is perpetuated in both disciplines. And no matter how much evidence to the contrary is presented, the operating room management refuses to recognize the safety of its use in this population of patients. This misunderstanding likely stems from the fact that seafood and shellfish contain high levels of iodine. But many other foods also contain iodine. In addition, the allergen causing anaphylaxis or other severe allergy with seafood/shellfish is NOT iodine. In fact, we learn in our medical education that iodine is a essential mineral needed for proper thyroid function. Just as in Heather’s example, I can present my colleagues with evidence to the contrary yet their ideas remain stable. I often wonder if these stable ideas are more difficult to change in adults that have completed their education (aside from the mandatory continuing education that is required of our professions). According to Posner et al, who refers to the change in stable ideas as accommodation, there are certain conditions that must be met before accommodation will occur:

1) there must be dissatisfaction with existing conceptions

2) a new conception must be intelligible

3) a new conception must appear initially plausible

4) a new concept should suggest the possibility of a fruitful research program

Given the above, I think the greatest barrier is dissatisfaction with existing conceptions. It seems that there isn’t enough motivation to change their existing conceptions, because there is minimal dissatisfaction with what they believe. One way to address this using digital technology is to use something like simulation to visually show the difference between using povidone-iodine as a skin preparation versus the alternative that is currently used in patients that have shellfish/seafood allergies. Or a visual presentation on molecular mechanism of seafood/shellfish allergy to demonstrate that their ideas are in direct contradiction to scientific findings. Just having a conversation without hands-on activities to engage them may not be effective.

While looking into misconceptions in medical education, I came across a really interesting article that looked at novice biology teachers, and their misconceptions (Yip, 1998). According to this article misconceptions in science after formal instruction can be categorized into three groups:

1) informal ideas formed from everyday experiences which children bring with them to the classroom

2) incomplete or improper views developed by students during classroom instruction

3) erroneous concepts propagated by teachers as well as textbooks.

Yip states that for many complex and abstract phenomena, such as mechanisms of circulation and other medical topics, children are less likely to develop their own explanations/ideas because they would be unlikely to come in direct contact with these topics in daily life. Thus, these misconceptions are derived from the latter two categories. In Yip’s study of 26 secondary biology teachers (all university graduates with majors in biological science), he identified many basic biological concepts that were misunderstood by them. Some of these misconceptions were a result of oversimplification of concepts and erroneous information propagated in some text books, as well as misuse or imprecise use of terminology. Perhaps this is another area that should be explored when looking into the origins of students’ misconceptions.