Information management

I always was a fierce defendant of evidence-based medicine. After all, what harm is there in finding, using and being able to reject the available evidence for a particular question. Although we never learned it in medical school, I did some postgrad courses on medical literature appraisal, ploughed through the User’s Guide and tried to understand the mechanics of metaanalysis. I also follow most of the relevant Neurology journals. Still, I am unable to answer any given bedside clinical question in the way EBM would have it. It just takes too long and I am too dumb. Properly reading a study takes hours and then I am not able to find all weaknesses that internet blogs find in it.

So either I am unsuited for  EBM or it does not work. Also, it just explains how to answer questions, not how to raise them.

With these fears in the background, I stumbled upon this paper and this talk, explaining a basic approach to what I would call informed medicine. I would add to the information in the article some core principles of work with medical literature:

  1. Try to stay current with the big journals (because they matter), but beware of their pharma influence.
  2. Try to stay current with some more independent and small journals (such as in PMC and the British journals).
  3. Follow informed discussions on the web (such as CCML, emcrit, …) in places where you reliably found good doctors.
  4. Don’t be an early adopter, unless a study has very small NNTs and has been replicated.
  5. Mistrust studies with thousands of participants, unless their (so-called scientific) results have been replicated in clinical practice.
  6. If facing a patient with a problem, read up in good textbooks written by people you trust and who are too old to be influenced by every small whiff of medical wind.
  7. Then confront this with something like uptodate.
  8. Finally read some reviews.

As a final remark, I offer the following strategy for finding a treatment for your patient: do a search on RCT with limits to 1970-1990 on your subject – you will find many rightfully abandoned approaches, but also some gems to be recovered.

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