The problem physician.

Under the contemporary avalanche of new biomedical discoveries, most physicians find themselves in a losing battle to keep up to date. An underappreciated but important consequence of this struggle has been an abdication of the traditional responsibility of clinicians to critically review novel findings. We appear as a group to prefer our data predigested. Understandably, but unfortunately, we have become too accepting of formal guidelines and trusting of expert advice. Imprecision in our thinking and misapplication of cutting edge technologies have resulted, often to the detriment of the individual patient and the society at large. This essay illustrates some specific examples that demonstrate how superficial knowledge and blind faith can promote suboptimal care and inappropriate use of resources. Reflexive approaches to problems erode the individuality of diagnostic and treatment plans. Accordingly, I challenge my colleagues to be more skeptical about the validity and utility of how they are directed to practice medicine.

Clinical Competence↗

PubMed2000

Users' Guides to the Medical Literature: XXV. Evidence-based medicine: principles for applying the Users' Guides to patient care. Evidence-Based Medicine Working Group.

This series provides clinicians with strategies and tools to interpret and integrate evidence from published research in their care of patients. The 2 key principles for applying all the articles in this series to patient care relate to the value-laden nature of clinical decisions and to the hierarchy of evidence postulated by evidence-based medicine. Clinicians need to be able to distinguish high from low quality in primary studies, systematic reviews, practice guidelines, and other integrative research focused on management recommendations. An evidence-based practitioner must also understand the patient's circumstances or predicament; identify knowledge gaps and frame questions to fill those gaps; conduct an efficient literature search; critically appraise the research evidence; and apply that evidence to patient care. However, treatment judgments often reflect clinician or societal values concerning whether intervention benefits are worth the cost. Many unanswered questions concerning how to elicit preferences and how to incorporate them in clinical encounters constitute an enormously challenging frontier for evidence-based medicine. Time limitation remains the biggest obstacle to evidence-based practice but clinicians should seek evidence from as high in the appropriate hierarchy of evidence as possible, and every clinical decision should be geared toward the particular circumstances of the patient.

Clinical Competence↗