Arnold Kling on EBM and the role of guidelines in today’s clinical decision making:
It is absurd to think that a baseball statistician, operating at a distance in time and space from a player being scouted, is able to make a better decision about the player’s likelihood of major league success than a local scout. Except that it happens.It is absurd to think that credit scoring models are better predictors of default than human underwriters. Except they are.
Today, we are in between two images of the doctor. One image is the heroic personal savior, who uses his own experience and intimate knowledge of the patient to make the best decisions. The other image is the trained technician, who gathers data, feeds it into a decision tree, and implements that recommended course of action.
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- The bionic arm
- Taking a stand against futile care
- A doctor treating their kid
- The crapshoot of emergency medicine
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{ 4 comments }
the problem is that they still fail to take into account how little of medicine has good data to support decisions. they fail to take into account that we still care about individual patients a lot more than whether we correctly identify who will be a 200 hitter and who will be a 300 hitter. i think if they are comparing someone who doesn’t keep up with the literature to practicing medicine from a distance, they possibly could demonstrate some benefit, if there were a way to fairly quantify these things.
i can’t believe how these people purport to understand data and still think that they can compare outcomes in a real life setting using said data.
Kling proposes that patients be made aware of the “statitical recommendations” and the doctor’s “personal recommendation,” and choose between them.
I wonder what Dr. Merenstein would have to say about that.
He’d probably whine about the fact that he was unfairly persecuted even though it will ultimately turn out that testing is a good idea and he never actually had any judgement against him. I wonder what Dan Fogelberg would say about that?
even though it will ultimately turn out that testing is a good idea
Can I borrow your crystal ball? With it, I won’t need any testing at all.
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