Really? Is that a fact?

While we are in the heat of the political season it seems a good time to to talk about the differences between opinions and facts. This comes up when writing professional papers, sharing health information with patients, discussing rules and regulations, and plain old conversations. How do you know what is an opinion? When does it matter? What can you do to check facts and differentiate between the two? In my role as a peer reviewer for journals and professional certification I see many instances where opinions are posited as fact; too many instances. Maybe a quick discussion will reduce the confusion.

Facts and Opinions

In simple terms a fact is something that has evidence and an opinion is a belief. When reporting a fact a person can provide data to substantiate the claim. For example, recently someone told me that the enrollment in medical schools is down and we will not have enough doctors to care for the retiring baby boomers. I wondered if this was a fact or an opinion. Doing a quick Google search I identified a source of data, the Association of American Medical Colleges, where the graduation numbers are given for medical schools between 2006 and 2011. This report shows higher numbers of graduates over time. It does not answer the question about enrollment, however the supply of physicians is dependent on graduation more than enrollment. Whether or not we will have enough physicians to care for the baby boomers is not just about graduating physicians, it is also about retirement rates and the demand. Even if the incoming doctors replace all the retiring doctors it may not be enough with the increased demand placed on the system due to an aging population. This presents another question, what if facts don't exist?

Sometimes data does not exist, or the data is based on assumptions. In the case of having enough physicians to care for the baby boomers the answer is based on a set of assumptions. These assumptions include the rate of retirement of existing doctors, demand for medical services by society, the efficiency created by technology (such as tele-medicine), cost of care and ability to pay for medical services, demand placed on medical care by the population who are not baby boomers, and population health strategies. Likely there are many other factors, the point in a projection is to assemble the most influential assumptions and provide support for them. A commission was created to look into this challenge and it published a report in 2008. This 106 page document, titled The Physician Workforce: Projections and Research into Current Issues Affecting Supply and Demand, digs through a complex process of looking at trends and creates a projection based on an extensive analysis. Of course the results are subject to the information at hand and influenced by the commission members, but the reader can follow the development of the assumptions. This makes the discussion open and allows for debate.

The same approach happens in a professional paper. An author states a position, such as too many papers are written where the author has unsupported opinions, and now the writer needs to provide the facts. Facts may not be available, a commission has not been created to count unsupported opinions. When facts are not available the author can turn to authoritative sources for related information. Here is an example of such an article. This would include articles published in peer reviewed journals. These journals have articles vetted before publication to assure an intended level of integrity and quality. Academic libraries often have a resource to help their students identify peer reviewed journals. Another resource is Google Scholar, a search engine that focuses on academic resources. With advanced settings the search can highlight the articles available in your geographic area or academic institution. Most of the articles found in a Google Scholar search are only available through subscriptions. An author can get access to subscriptions through hospital affiliations, professional associations, and alumni memberships. Another important resource is your public library. Many public libraries have arrangements with state and private colleges to share information. With a public library card an author can obtain copies of articles or books delivered through an inter-library loan. Supporting a position with authoritative sources gives credibility to the statement, and the author.

When it matters

Professional associations and journals set standards for their organizations on the strength they require in stating facts. An author can find out the requirements by reviewing existing publications and the instructions for submissions. This is also a good place to understand the style expected by the publication for documenting the references and citations. Conversations are another matter. When we are talking with colleagues and friends about important topics a reference list is not expected. However, you can evaluate the information by asking about the source. Where did you learn that? How did you come to know this? Where can I learn more about what you said? These questions can give you a basis to review the information. Be wary of open sources, such as Wikipedia. These sources allow for anyone to contribute information, without review. Such a source might help you craft a better question or identify key individuals in the field, it will not be authoritative. The journals and organizations where I review papers will not accept references from Wikipedia or other open source data repositories.

Conclusion

As of right now I still don't know if we will have enough physicians to meet future needs. The paper written by the commission suggests that we have a modest shortfall in our future supply. Since this is a dynamic question and the paper was written 4 years ago, I am inclined to believe the information is out of date. I'm taking the position that I don't have enough evidence and need to look at it further. Online information is readily available and professionals must support their work. It makes us accountable, and I might ask you to share your source!