Dear List members,
This is not at all what I meant; I disagree strongly with the spin Kevin
has put on my message. I'd prefer just to disregard his comments, but I
don't want to acquiesce by silence.
Regards,
Sue
=================================================
At 9:27 PM 12-21-00, Kevin Owen wrote:
>Hello Susan
>
>Its good to see someone speaking out about Evidence Based Health not based
>on Evidence.
>
>Hows this for an example
>
>As a New York psychiatrist Ron Leifer says,his profession will find a mental
>illness in everything and there is no science in it:
>"Everyone is neurotic.I have no trouble giving out diagnosis.In my office,I
>only see abnormal people.Out of my office,I see only normal people.Its up to
>me.Its just a jokeThis is what I mean by this fraud,this arrogant fraud...To
>make some kind of pretention that this is a scientific statement
>is....damaging to the culture..."
>
>Sciences parisite:The Old "Science Positioning Ploy"
>http://www.cchr.org/indxcchr.htm
>
>It will be interesting to see how long they can keep the pretense up.It is
>getting harder to do that now as more people are asking questions even
>inside the ranks
>
>Regards
>
>Kevin
>
>
>-----Original Message-----
>>From: Susan Kaiser, M.D. <[log in to unmask]>
>>To: [log in to unmask]
>><[log in to unmask]>
>>Date: Thursday, 21 December 2000 08:58
>>Subject: Re: FW: Teaching EBM
>>
>>
>>>Dear Dan,
>>>
>>>I agree that these are crucial questions. If you can't answer them, it's
>>>hard to pursue and evidence-based approach oneself, much less advocate its
>>>use to others.
>>>
>>>>> 1. What ideas do people have about dealing with the frustration
>>frequently
>>>>> encountered by the realization that for many clinical questions, there
>>are
>>>>> no evidence-based answers? How do you keep the residents from
>dismissing
>>>>> the whole concept because they cannot yet always find answers in a
>>prompt
>>>>> manner?
>>> This represents a failure of concept rather than of practice.
>Real
>>>solid answers are lacking to many or most medical questions no matter what
>>>approach you use, EBP or otherwise. The entire goal of evidence-based
>>>practice is to find, recognize, and use the best available evidence. If
>>>you are all alone in the desert, maybe the best evidence is in your head.
>>>If you are at a major medical center, it's likely to be electronically
>>>available from the library. And the best evidence may not be very good,
>at
>>>that, but part of EBP is being able to assess how good the evidence is.
>>>Know the quality of the basis for your decisions, and use the best you can
>>>get. That's what EBP teaches you how to do.
>>> Residents might be interested to know how little of what they are
>>>authoritatively taught is based on real evidence. It might be good for
>>>them to know this.
>>>
>>>>> 2. (A question and a request) How valuable do people find the process
>of
>>>>> structuring the clinical question, per Sackett and others? While it
>>makes
>>>>> sense to me to have the residents think about the question they are
>>asking
>>>>> and focus it, the formal structuring of patient/problem, intervention,
>>>>> comparison, and outcome doesn't always assist in the process of
>>searching
>>>>> for the answer - the search engines do not accept this structure to a
>>>>> query. Thus the request to those of you who are working on the FPIN as
>>>>> well as others - wouldn't it be nice if we had a database that could be
>>>>> searched by structuring and then asking your question in this format,
>or
>>>>> at least in a way that facilitated the process of moving from the
>>clinical
>>>>> situation to the information needs in a relatively direct way.
>>> My thought about this, and I'll try to be less long-winded, is
>that
>>>the primary purpose of the properly formulated question is to define what
>>>you are asking, to enable you to decide whether you have found an answer,
>>>and to help determine what may be missing from what you have found. I
>>>agree completely that the question isn't much help in doing a search, as
>it
>>>is generally so specific that if you got any hits you'd be very lucky!
>>>
>>>I will be very interested in what others have to say.
>>>
>>>Regards,
>>>Sue
>>>
>>>Susan Kaiser, MD
>>>Department of Surgery, Box 1259
>>>The Mount Sinai School of Medicine
>>>New York, NY 10029
>>>
>>>[log in to unmask]
>>
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