We need ideas based medicine
BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3432 (Published 25 August 2009) Cite this as: BMJ 2009;339:b3432All rapid responses
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EBM has shown that sometimes we spout rubbish. Google etc has really
ended the need for detailed knowledge of facts (just look it up on your
PDA). Experience can be abused with the wrong ego. However the real clash
is that experience is pattern recognition which is instant, cognitively 3D
and subconscious whereas EBM/guidelines are time consumptive, conscious
and linear. You can do both at the same time and that is the challenge.
Competing interests:
None declared
Competing interests: No competing interests
Whilst Des Spence has hit the nail on the head yet again he is
perhaps only revealing his age and experience! Like Moses coming down from
Mt. Sinai to find the Israelites worshiping a golden calf, we oldies are
surrounded by young ones who know everything but understand nothing! In my
specialty, we have thrown out ideas, physiology and measurement and only
welcome the results (mostly negative supporting the null hypothesis) of
large multicentre randomised trials. Perhaps I am a bit "'burnt out" but I
can no longer deal with our ethics committee that demands endless forms to
allow the performance of simple physiological observations. The followers
of the new religion will receive their reward in due course - but in the
meanwhile, their self-righteous declarations and posey acronyms are going
to bore us all to death!
Competing interests:
None declared
Competing interests: No competing interests
Wholly wrong on (at least) two counts
Des Spence is wholly wrong that “experience has been
dismissed by the absolutism of evidence based medicine.” One
of the very first editorials on evidence based medicine—in
the BMJ—begins with the line that evidence based medicine
“is about integrating individual clinical expertise and the
best external evidence.” (1)
Spence also writes that there is a “need [for] a forum for ideas
from practising doctors,” but there are many such forums—not
least the BMJ’s case reports journal and the two Biomed
Central journals on case reports. Cases Journal, the one I
edit, explicitly encourages GPs to submit any case, arguing
that they don’t have to be judged “original and important”
because all cases if carefully considered are original and
important, not least to the patient.
Earlier in his piece, Spence writes: "Sadly, most doctors
are not in a position to…even produce case reports.” Why
not? If Spence can write a column every week he can
certainly write a case report. And, as everybody knows, you
can get any rubbish published if you persist long enough.
1 Sackett DL, Rosenberg WMC, Muir Gray JA, , Haynes RB,
Richardson WS. Evidence based medicine: what it is and what
it isn't. BMJ 1996; 312: 71 - 2 .
Competing interests:
I'm the editor of Cases
Journal
Competing interests: No competing interests