3 ms·

I'm a physician and I've been suggesting this to my colleagues for a few years, only to be met with alienated stares and labeled cynical. The doctors and docto

I'm a physician and I've been suggesting this to my colleagues for a few years, only to be met with alienated stares and labeled cynical. The doctors and doctors-in-training I work with have altruistic motives, but place too much stock in major medical studies. They also frequently apply single-study findings to patient care, even to patients that would've been excluded from that study (saw this a lot with the recent SPRINT blood pressure trial). And don't even get me started on the pulmonary embolism treatment studies. What a clinical mess that is. It's frustrating.

appleflaxen 10y ago
but in medicine, what is the practical alternative? how do you incorporate these findings? ignore them? if so, it's probably bad for your patients. the only thing worse than a single-study finding is a zero-study finding.
- mablap 10y ago
  No. Step 1: Do no harm. In practice, this means staying up to date on the latest research (by law), but follow the guidelines. These are updated regularly, just not after each and every study that comes out. And it's a good thing a lot of doctors exercise caution.
- undergroundOps 10y ago
  I was simply suggesting what we all learn in medical school and residency: to appropriately evaluate clinical studies. Just don't think most doctors do. Let me give you an example of how I approach things. The guidelines for acute pancreatitis recommend using a fluid called LR instead of NS for volume resuscitation. This is based on an single study that included 10 patients and simply noted slightly better lab numbers; there was no difference in clinical outcome. Lots of problems with that study, right (small, underpowered, confounders, validity issues, etc)? However, there's no major disadvantage for using LR in those patients (unless hyperkalemia is a concern), so I use it since it might have a benefit. This is a very simple example. It gets much more complicated than that. "Probably" is one of favorite words in medicine, btw :).
  - mablap 10y ago
    "Probably" is one of favorite words in medicine, btw :). Right as it should. If somebody answers my question by "It depends", then I know I'm in good company!
  - triangleman 10y ago
    And the root of the word "probably" is latin probare meaning "to test". As in, you have to have some empirical basis for your belief in the likelihood of something.
- pshc 10y ago
  Apply Bayesian reasoning. Weigh results appropriately.
mablap 10y ago
Personal experience (I've met many pre- and current doctors during my studies) suggests that few doctors are scientists. They know a lot of things, but they're not what I'd call scientists in the same way a physicist or biologist would be (and I've often wondered why they'd get a "Doctorate" at all). So this might explain the abovementioned behaviour... Yet I'm surprised by your colleagues behaviour nonetheless. I would have thought they'd have more retenue.
- undergroundOps 10y ago
  I also wouldn't call most of us scientists, though many at university hospitals are. I think the problem is that it's simpler to just take a study's conclusion and believe it. Because hey, it's peer-reviewed and in the NEJM! Easy! The adverse reaction I described is normal in medicine when you oppose the status quo. That's probably true in other professions and industries.
- Obi_Juan_Kenobi 10y ago
  Aside from MD/PhD's, medical doctors are not trained in research or evaluating evidence, so are not scientists by any reasonable definition.
Madmallard 10y ago
Can I have you as my PCP? I had a severe reaction to fluoroquinolones and maybe some confounding comorbidities and have been pretty much unable to get effective help in our medical system so far :(
77pt77 10y ago
> And don't even get me started on the pulmonary embolism treatment studies. What a clinical mess that is. Please, start. I'm very interested and will read what you write with full attention.

appleflaxen 10y ago

but in medicine, what is the practical alternative? how do you incorporate these findings? ignore them? if so, it's probably bad for your patients. the only thing worse than a single-study finding is a zero-study finding.

mablap 10y ago
No. Step 1: Do no harm. In practice, this means staying up to date on the latest research (by law), but follow the guidelines. These are updated regularly, just not after each and every study that comes out. And it's a good thing a lot of doctors exercise caution.
undergroundOps 10y ago
I was simply suggesting what we all learn in medical school and residency: to appropriately evaluate clinical studies. Just don't think most doctors do. Let me give you an example of how I approach things. The guidelines for acute pancreatitis recommend using a fluid called LR instead of NS for volume resuscitation. This is based on an single study that included 10 patients and simply noted slightly better lab numbers; there was no difference in clinical outcome. Lots of problems with that study, right (small, underpowered, confounders, validity issues, etc)? However, there's no major disadvantage for using LR in those patients (unless hyperkalemia is a concern), so I use it since it might have a benefit. This is a very simple example. It gets much more complicated than that. "Probably" is one of favorite words in medicine, btw :).
- mablap 10y ago
  "Probably" is one of favorite words in medicine, btw :). Right as it should. If somebody answers my question by "It depends", then I know I'm in good company!
- triangleman 10y ago
  And the root of the word "probably" is latin probare meaning "to test". As in, you have to have some empirical basis for your belief in the likelihood of something.
pshc 10y ago
Apply Bayesian reasoning. Weigh results appropriately.

mablap 10y ago

Personal experience (I've met many pre- and current doctors during my studies) suggests that few doctors are scientists. They know a lot of things, but they're not what I'd call scientists in the same way a physicist or biologist would be (and I've often wondered why they'd get a "Doctorate" at all). So this might explain the abovementioned behaviour... Yet I'm surprised by your colleagues behaviour nonetheless. I would have thought they'd have more retenue.

undergroundOps 10y ago
I also wouldn't call most of us scientists, though many at university hospitals are. I think the problem is that it's simpler to just take a study's conclusion and believe it. Because hey, it's peer-reviewed and in the NEJM! Easy! The adverse reaction I described is normal in medicine when you oppose the status quo. That's probably true in other professions and industries.
Obi_Juan_Kenobi 10y ago
Aside from MD/PhD's, medical doctors are not trained in research or evaluating evidence, so are not scientists by any reasonable definition.

Madmallard 10y ago

Can I have you as my PCP? I had a severe reaction to fluoroquinolones and maybe some confounding comorbidities and have been pretty much unable to get effective help in our medical system so far :(

77pt77 10y ago

> And don't even get me started on the pulmonary embolism treatment studies. What a clinical mess that is. Please, start. I'm very interested and will read what you write with full attention.