Interpreting research findings to guide treatment in practiceBMJ 2008; 337 doi: http://dx.doi.org/10.1136/bmj.a1499 (Published 24 October 2008) Cite this as: BMJ 2008;337:a1499
- Tony Kendrick, professor of primary medical care1,
- Kelsey Hegarty, associate professor2,
- Paul Glasziou, director3
- 1University of Southampton, Primary Medical Care, Aldermoor Health Centre, Southampton SO16 5ST
- 2University of Melbourne, Department of General Practice, Carlton 3053, Australia
- 3Centre for Evidence-Based Medicine, University of Oxford, Department of Primary Health Care, Oxford OX3 7LF
- Correspondence to: T Kendrick:
- Accepted 30 March 2008
Trials are important but not sufficient for good clinical decision making. Recommendations derived from trials in groups of patients must be interpreted and adapted by clinicians to the context of each individual patient seen in practice.1 The spectrum of patients in primary care is often very different from that in secondary care and clinical trials. In general, practitioners have two options: to consider how the treatment’s benefits and harms will differ given the severity, risk, and context of the individual patient, or to use a “try it and see” approach (or, more formally, do an “n of 1” trial). There is a range between these options. Take the example of the case of depression described in box 1.
Box 1 A patient with depression after marriage break up
A 54 year old man presents with low mood after separating from his wife of 30 years. He is usually seen only twice a year for review of his epilepsy drugs, tends to play down his symptoms, and has no history of depression. He has been unable to work for three weeks owing to reduced sleep, energy, appetite, and lack of motivation. He is now living alone in bed and breakfast accommodation and drinking more alcohol, is having thoughts about suicide but has no specific plans, and is not keen on antidepressants as he believes they can be addictive. He scores 14 out of 27 on the patient health questionnaire (PHQ-9), indicating mild major depression.2 The GP discusses the pros and cons of antidepressants, explores with the patient what strategies he will use to address his situation, and certifies …
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