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Re: Episiotomy question --> EMB From: allanho@aol.com Mon Feb 18 13:38:48 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Efrain Ramirez: "Re: Episiotomy question-Woolley - long" Previous message: Efrain Ramirez: "Re: Episiotomy question" In reply to: DoctorJoe@aol.com: "Re: Episiotomy question --> EMB" Next in thread: Joanne Bulley, MD: "Re: Episiotomy question --> EMB" I think you are trying to say "absence of evidence is not evidence of absence".? Some people are incapable of grasping this concept. Allan -----Original Message----- From: DoctorJoe@aol.com To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.obgyn.net> Sent: Mon, 18 Feb 2008 11:29 am Subject: Re: Episiotomy question --> EMB 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. 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. Content-Transfer-Encoding: 7bit Content-Type: text/html; charset="us-ascii" I think you are trying to say "absence of evidence is not evidence of absence".&nbsp; Some people are incapable of grasping this concept.<br> <br> Allan<br> <br> -----Original Message-----<br> From: DoctorJoe@aol.com<br> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.obgyn.net><br> Sent: Mon, 18 Feb 2008 11:29 am<br> Subject: Re: Episiotomy question --> EMB<br> <br> <div id=AOLMsgPart_2_2f3272fa-e227-4d1d-b7fb-10a896a678f6><FONT face=arial,helvetica><FONT face=Geneva color=#000000 size=2><br> In a message dated 2/18/08 2:59:27 AM, <A href="mailto:AllanHo@aol.com">AllanHo@aol.com</A> writes:<br> -- <br> <BLOCKQUOTE TYPE="CITE"></FONT><FONT face=Geneva color=#000000 size=2>I don't know why you are telling me that - it is obvious that evidence based medicine is preferable.&nbsp;In the absence of evidence, you can only go by people's experience.&nbsp; There are so many variables when it comes to shoulder dystocia.&nbsp; Every case is different.&nbsp; I am not sure what you are trying to get at.<br> </BLOCKQUOTE></FONT><FONT face=Geneva color=#000000 size=2><br> <br> Pet peeve of mine.<br> <br> 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.<br> <br> The problem is two-fold.<br> <br> 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. <br> <br> To repeat: It is wrong to censure someone for not having evidence based support for their practice IF NONE EXISTS.<br> <br> 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. <br> <br> This is my complaint that protocols and pathways tend to mediocritize medicine, rather than elevating the standard (as they are apparently meant to do).<br> <br> "That is not logical, Captain" -- Spock<br> <br> Joe P.<br> <br> </FONT><FONT face=Geneva color=#000000 size=2></FONT><br> <br> <!-- end of AOLMsgPart_2_2f3272fa-e227-4d1d-b7fb-10a896a678f6 --></FONT><div class="AOLPromoFooter"> <hr style="margin-top:10px;" /> </div> Next message: Efrain Ramirez: "Re: Episiotomy question-Woolley - long" Previous message: Efrain Ramirez: "Re: Episiotomy question" In reply to: DoctorJoe@aol.com: "Re: Episiotomy question --> EMB" Next in thread: Joanne Bulley, MD: "Re: Episiotomy question --> EMB"

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