Intended for healthcare professionals


Personal knowledge

BMJ 2006; 332 doi: (Published 19 January 2006) Cite this as: BMJ 2006;332:129
  1. Kieran Sweeney (, honorary clinical senior lecturer in general practice
  1. Peninsula Medical School, Exeter EX2 5DW

    Doctors are much more than simple conduits for clinical evidence

    Choudry and colleagues' paper in this issue (p 141) is a brave attempt to quantify the under-recognised notion of personal knowledge in clinical practice.12 They carefully analysed the prescribing decisions of hospital doctors caring for patients with atrial fibrillation, before and after their exposure to a patient with an adverse event—either serious haemorrhage when taking warfarin, or a thromboembolic event while not taking warfarin. The researchers wanted to know whether doctors' knowledge of a previous adverse event affected their subsequent prescribing.

    For the group of doctors who were exposed to patients with adverse bleeding events, and who cared for atrial fibrillation patients subsequently, the odds that they would prescribe warfarin were 21% lower for subsequent patients. There was no statistically significant change in warfarin prescribing after a doctor cared for a patient …

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