Re: Episiotomy question --> EMB
From: R. Daniel Braun (rd.braun@gmail.com)
Mon Feb 18 11:17:30 2008
Not to mention when the evidence based medicine is based on flawed evidence.
Dan
On Feb 18, 2008 11:29 AM, <DoctorJoe@aol.com> wrote:
>
> In a message dated 2/18/08 2:59:27 AM, AllanHo@aol.com writes:
>
> I don't know why you are telling me that - it is obvious that evidence
> based medicine is preferable. In the absence of evidence, you can only go by
> people's experience. There are so many variables when it comes to shoulder
> dystocia. Every case is different. I am not sure what you are trying to
> get at.
>
> Pet peeve of mine.
>
> We all "agree" that medicine based on evidence is best. I don't know
> anyone who would (at least overtly) disagree with that. Apparently, that's
> what "modern" medicine is becoming based upon more and more. That's one
> thing.
>
> The problem is two-fold.
>
> 1) If there is NO evidence based medicine on a particular topic, then that
> means you MUST use "eminence based" medicine, as el terms it. You have
> nothing else to go on. However, what some people would argue (often when
> they want to attack another doctor for some reason -- usually money) is that
> if there is no evidence to support some practice, then it means the practice
> must be wrong. This is backwards logic. Obviously, if there is evidence
> based medicine to contradict the practice, that's one thing. But in the face
> of NO EXISTING evidence based strategy, then you should only be required to
> articulate some plausible scientific argument, be it basic science,
> professorial opinion, or whatever.
>
> To repeat: It is wrong to censure someone for not having evidence based
> support for their practice IF NONE EXISTS.
>
> 2) Secondly, if evidence based data exists to support some medical
> practice, that does not (usually) make that practice appropriate for ALL
> PATIENTS. If a practitioner treating a patient determines that the patient's
> parameters do not fall within the evidence based window, she should be free
> to vary the treatment as appropriate for that patient. There has to be room
> for clinical opinion, otherwise we can simply let robots make the decisions
> and have chimpanzees treat the patients.
>
> This is my complaint that protocols and pathways tend to mediocritize
> medicine, rather than elevating the standard (as they are apparently meant
> to do).
>
> "That is not logical, Captain" -- Spock
>
> Joe P.
>
--
R. Daniel Braun, MD FACOG(L) ABMP CMTh
Professor Emeritus
Dept. of Obstetrics and Gynecology
Indiana U. School of Medicine
R. Daniel Braun
"Science without Religion is LAME; Religion without Science is BLIND"
Einstein 1941
