Sunday, December 1, 2013

Six dangerous words

There's an interesting essay in JAMA this week entitled EBM's Six Dangerous Words. In it, Scott Braithwaite argues that physicians should banish the phrase "there is no evidence to suggest that..." He gives as an example: there is no evidence to suggest that looking both ways before crossing a street compared to not looking both ways reduces pedestrian fatalities. While that's technically true, as he puts it, such statements presume "a definition of evidence that requires formal hypothesis testing in an adequately powered study." It makes objective certainty the be-all and end-all, and "is ambiguous while seeming precise." I have heard hospital epidemiologists state that there is no evidence to suggest that white coats can transmit infections in the healthcare setting. Ok, but sometimes the common sense of the average Joe trumps the best the medical literature has to offer. Or so it should...

8 comments:

  1. It's one of those verbal loopholes used to remove liability.

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  2. Mike,
    I am sorry to inform you that I wore a white coat on my last consult block. This was after close to two years of not wearing a white coat!!!
    Reason? Lack of evidence....

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  3. Silvia:
    You EBM purist! Please tell me you have not stopped looking both ways when crossing the street.

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    1. Mike. Sylvia is in Miami, they drive across the street. Silvia, Mike meant to ask if you looked both ways when crossing two-lanes of bidirectional traffic while driving.

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  4. Well, I have to say that after having such a long hiatus, it was nice to wear a white coat. I feel bad about the following, BUT, wearing a white coat makes you feel like a doctor...especially when all your peers wear one.

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    1. I am waiting for the lightening to strike me...

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  5. A number of years ago I moved to a different country and healthcare setting and started working there. I was baffled to see that the neonatal intensive care unit (NICU) in that setting was carpeted; the unit cared for premature neonates of ~500 g. Before the change of settings, I could not have imagined any hospital in the world having carpets in patient treatment areas, let alone NICUs. I did what I thought was dutiful and complained about the infection risk from the carpets. A senior staff member responded -- proudly -- that the unit strictly practices evidence-based medicine and explained that there was no evidence to suggest that carpets have any negative effects in NICUs and therefore -- by way of necessary conclusion -- it was OK to have carpets in NICUs. This incident was a career-changing moment for me. Medicine would never be the same again . . .

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    1. Thanks for your comment. If only more folks understood the Bayesian approach we would have safer hospitals.

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