An attending's perspective on information in medicine
This week's JAMA has an interesting piece written from the perspective
of an attending physician, considering how the role of the mentor in
clinical medicine has evolved with increasing availability of
information (mentions PDAs, UpToDate, PubMed, among other things).
An excerpt:
It has become increasingly clear to me that with the information
revolution in full throttle, the role of the clinical attending has
changed drastically and continues to evolve. Besides using rounds
to discuss many of the social, ethical, and professional issues
surrounding a patient's care, I increasingly find myself teaching
less about the current state of information and more about how
things have changed and how our understanding of an illness or
treatment has evolved to where it is currently. I teach about
multiple portals--how there is no single way to approach a case and
how the one we choose may not be the only or even the best strategy
despite our attempts to get the facts right and review the relevant
data. I have the distinct impression that my mentors possessed a
degree of certainty that in hindsight I am not sure was warranted.
In this era of evidence-based medicine, I am more likely to point
out how scanty the evidence actually may be when making a decision.
Although I may refer to the "classic" article in a particular
field, all too often I will point out how in retrospect it looks
much less convincing than when it was first published just 10 years
ago. Rather than giving my team answers, I am more likely to ask
them to formulate a question that interests them regarding a
specific case, then investigate the data, and report back to the
group. The group can then try to digest this information and place
it in the context of the case at hand.
Reference:
Horowitz HW. The Interpreter of Facts. JAMA 2008;299: 497-498.
Labels: evidence based medicine
posted by Becky at 2:16 PM
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