BMJ  2006;332:129-130 (21 January), doi:10.1136/bmj.332.7534.129

Editorial

Personal knowledge

Doctors are much more than simple conduits for clinical evidence

The first 150 words of the full text of this article appear below.

Choudry and colleagues' paper in this issue (p 141) is a brave attempt to quantify the under-recognised notion of personal knowledge in clinical practice.^{1 2} They carefully analysed the prescribing decisions of hospital doctors caring for patients with atrial fibrillation, before and after their exposure to a patient with an adverse event—either serious haemorrhage when taking warfarin, or a thromboembolic event while not taking warfarin. The researchers wanted to know whether doctors' knowledge of a previous adverse event affected their subsequent prescribing.

For the group of doctors who were exposed to patients with adverse bleeding events, and who cared for atrial fibrillation patients subsequently, the odds that they would prescribe warfarin were 21% lower for subsequent patients. There was no statistically significant change in warfarin prescribing after a doctor cared for a patient who had had a stroke while not taking warfarin, nor—in support of the specificity of . . . [Full text of this article]

Peninsula Medical School, Exeter EX2 5DW
(kieran.sweeney@pms.ac.uk)

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