A good readBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7556.0-f (Published 22 June 2006) Cite this as: BMJ 2006;332:0-f
- Fiona Godlee, editor ()
If you're looking for a couple of slim volumes to read on your travels this summer, look no further. Here are two books to divert, improve, and inform. Firstly, Testing Treatments by Imogen Evans, Hazel Thornton, and Iain Chalmers is, according to our reviewer Ike Iheanacho, “a terrific little book” (p 1516). Its premise is that “knowledgeable ignorance” is something to aspire to. We should embrace uncertainty and stop feeling that we need to pretend that we know all the answers. Instead, say the authors, we should be rigorously questioning whether what we and others do is truly effective, since logic and good intentions are not enough. Sure Start, the UK government's programme for children in socially deprived communities, is a case in point: a study in this week's BMJ finds that, although it helps some children, it may actually be harming those most in need. The government ruled out a randomised trial at the start of the programme so we may never know whether it works, which is a pity.
On a more positive note (and before I get on to my next good read), we are seeing more well done surgical trials in the BMJ. This week, Isam Astroshi and colleagues report their randomised trial of open versus endoscopic surgery for carpal tunnel syndrome (p 1473). The problem here has been postoperative pain and time taken off work, with the assumption that endoscopic surgery would cause less of both. Improving on the design of previous trials, Astroshi and colleagues found less postoperative pain but little improvement in time off work. In his editorial this week (p 1463), Brent Graham concludes that the problem now in carpal tunnel is not which surgery to choose but being sure you've got the right diagnosis. Which leads me to my next good read—Clinical Thinking by Chris Del Mar, Jenny Doust, and Paul Glasziou—which we will review in the BMJ shortly.
Chapter 4, on diagnosis, is especially good, exploring why clinicians make diagnostic errors, the role of intuition, and how to teach diagnostic reasoning. As J A Ryle wrote in 1948 (quoted at the start of the chapter), “the three main tasks of the clinician are diagnosis, prognosis and treatment. Of these, diagnosis is by far the most important for upon it the success of the other two depend.” But the evidence base for diagnosis is far less mature than for treatment. A few weeks ago in an editorial, Peter Rothwell exhorted us all to focus more effort on basic observational research, which would, among other things, support better diagnosis. We'd like to see such studies in the BMJ, and we publish one such as an Online First this week. In their rural general practice, Jennifer du Toit and colleagues investigated all patients more than 45 years old who developed new rectal bleeding. One in 10 had colon cancer, and the authors conclude that all such patients should be investigated. I hope Peter Rothwell will agree that this is a useful clinical message, and that, if neither of the two books I've listed appeals to you, you'll send us your own recommendations for a good read this summer.
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