Comments on: Can patients and doctors handle the truth? http://www.kevinmd.com/blog/2009/04/can-patients-and-doctors-handle-truth.html medical blog Sun, 22 Nov 2009 14:15:05 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Manalive http://www.kevinmd.com/blog/2009/04/can-patients-and-doctors-handle-truth.html/comment-page-1#comment-90814 Manalive Sat, 11 Apr 2009 18:38:00 +0000 http://clients.emmense.com/kevinmd/2009/04/can-patients-and-doctors-handle-the-truth.html#comment-90814 Not so fast, Kevin: there are plenty of examples the other way. For example, my common sense always told me that tight diabetic control in elderly hospitalized patients was fraught with problems, and now - after years of finger-pointing by various authorities - my common sense is proving correct.<br/>Also, I'm old enough to remember med school lectures never to use beta blockers in an MI or CHF for fear of negative inotrope effects; it was evedenced-based research that later said to use them - not theory or "ideology".<br/>There's lots of hidden ideology in evidence-based medicine: who decides what null hypothesis is funded or published?<br/>Finally, evidence-based medicine yields facts, not truths. It is when small facts are turned into big truths; e.g. when one small study of hospitalized diabetics is morphed into a mandatory truth -defying common sense - that all hell breaks loose. Not so fast, Kevin: there are plenty of examples the other way. For example, my common sense always told me that tight diabetic control in elderly hospitalized patients was fraught with problems, and now – after years of finger-pointing by various authorities – my common sense is proving correct.
Also, I’m old enough to remember med school lectures never to use beta blockers in an MI or CHF for fear of negative inotrope effects; it was evedenced-based research that later said to use them – not theory or “ideology”.
There’s lots of hidden ideology in evidence-based medicine: who decides what null hypothesis is funded or published?
Finally, evidence-based medicine yields facts, not truths. It is when small facts are turned into big truths; e.g. when one small study of hospitalized diabetics is morphed into a mandatory truth -defying common sense – that all hell breaks loose.

]]> By: Dr. IKE http://www.kevinmd.com/blog/2009/04/can-patients-and-doctors-handle-truth.html/comment-page-1#comment-90798 Dr. IKE Fri, 10 Apr 2009 15:04:00 +0000 http://clients.emmense.com/kevinmd/2009/04/can-patients-and-doctors-handle-the-truth.html#comment-90798 I think Dr. Newman makes an excellent point. I often wonder how much ego plays a part in specific recommendations. For my part, I know there are times when referring a patient makes me think "Man, I really thought I could help that person." <br/><br/>Maybe that's just the growth of a young doctor, I'd just think years of experience would make it more challenging to accept research-based evidence that may be contrary. I think Dr. Newman makes an excellent point. I often wonder how much ego plays a part in specific recommendations. For my part, I know there are times when referring a patient makes me think “Man, I really thought I could help that person.”

Maybe that’s just the growth of a young doctor, I’d just think years of experience would make it more challenging to accept research-based evidence that may be contrary.

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