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EDITOR'S CHOICE: Fiona Godlee Obviously BMJ 2006; 333: 0-f [Full text]

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physician waiting before action, pending evidence or meta analysis

Munir E Nassar, M.D., Pittsford, NY 14534-2566   (18 October 2006)

physician waiting before action, pending evidence or meta analysis 18 October 2006
Munir E Nassar, M.D., Academic physician without university affiliation 17 Cobblefield Way, Pittsford, NY 14534-2566, Pittsford, NY 14534-2566 Send response to journal: Re: physician waiting before action, pending evidence or meta analysis	Whereas, reading the results of meta analysis on an unresolved clinical problem, or collecting evidence based data is well and good, however, clinical medicine through its history relied on clinical experience and the well founded medical knowledge of the physician. In many clinical situations the physician has to take the best course of action for his patient and more often than not cannot wait for the results of the meta analysis. Some times the latter is redundant. As an observer, evidence based data is really not crucial in solving a problem. To wit, a patient in the intensive care unit, airway intubated, and with a nasogastric feeding tube and a foley catheter in his bladder and swan ganz catheter, I do not need a meta analysis to inform me that the patient is prone to aspiration pneumonia, or urinary tract infection or bacteremia. A recent article in the Annals of Internal medicine {October 17, 2006} entitled "Device-Associated Nosocomial Infections in..." {in several thousand patients} in 8 developing countries' ICUs, proves my point. The obvious is quite obvious. Individualizing each clinical problem of patients many times obviates waiting for remote statistical percentages. Competing interests: None declared