Using research findings in clinical practiceBMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7154.339 (Published 01 August 1998) Cite this as: BMJ 1998;317:339
All rapid responses
We would like to point out some of the question that arise in our
postgraduate classes after reading the article of S.E. Straus and D.L.
Sackett BMJ 1998;317 339-42.
The five steps classified by the authors to implement ebm in general
practice, to our opinion, underevaluate the "crucial step" that a general
Practitioner is used to meet in her job. To convert the information
received from the patient into a clinically relevant, answerable question
is the most difficult and fuorviante passage that we meet in our practice.
Our experiences (one in Verona , the other in Trento) show that many
different point of view may arise from the "confused" story of our
patients. In the class of Verona we used the same example that Trisha
done in the Wonca Conference in Dublin (an old man recently bereaved,
suffering from arthritis, who came in the practice without a clear reason
and leaving after a while unsatisfacted and the doctor too is feeling
frustrated by this consultation) asking to the trainees which was their
opinion in such a case. The result in a small workgroup of 8 people were 5
different items to be investigated to manage better this consultation.
Only at the end one of the
trainees pointed out the problem of the diagnosis of depression in general
practice (this was the suggested "answerable question" of the exercise of
Trisha Greenhalg in Dublin), because they believed that depression is a
diagnosis usually obtained from the history of the patient in general
practice, while the problem of "which kind of therapy" seemed to our
trainees most focused to solve the "real problem of the patient". In
Trento the exercise was the contrary: we started asking to the trainees to
tell the problem set up by the patients during a practice. The second
step was to define the "answerable question" for bibliographic research.
Again we obtained a large spectrum of items to be researched starting from
the same practice situation. Proper answer to a wrong problem is a risk of
applying the five steps of the mentioned article. We believe that further
efforts should be done to investigate clearly which is the true problem
that the patient is bringing
to our practice.
Better skill to evaluate properly the real need of the patient using
anthropological and behavioural sciences is expected in general practice
to implement properly the evidence based medicine.
36031 Dueville (VI)
Competing interests: No competing interests