As additional "armour" - although probably not the most useful
metaphor when dealing with educational aikido! - I would dig out the
following article. Personally I find the distinction between general
critisms of medicine, criticisms of EBM and misconceptions of EBM
a useful way of planning my defence (and their examples are good
too!):
CMAJ 2000 Oct 3;163(7):837-41
Evidence-based medicine: a commentary on common criticisms.
Straus SE, McAlister FA
Division of General Internal Medicine, Mount Sinai Hospital, Toronto,
Ont.
Discussions about evidence-based medicine engender both
negative and positive reactions from clinicians and academics.
Ways to achieve evidence-based practice are reviewed here and
the most common criticisms described. The latter can be classified
as "limitations universal to the practice of medicine," "limitations
unique to evidence-based medicine" and "misperceptions of
evidence-based medicine." Potential solutions to the true limitations
of evidence-based medicine are discussed and areas for future
work highlighted.
> In message <[log in to unmask]>, K.Hopayian
> <[log in to unmask]> writes
> >I am booked to give an introductory talk to two groups of general
> >practitioners in this part of England, East Anglia. The first is a
> >group of GPs attending an annual refresher course, the second a group
> >of trainers and their trainees (called registrars in England). Both
> >groups contain individuals hostile to EBM (though none have had
> >direct exposure, I suspect).
> >
> >My plan is to use *educational aikido* - that is, let them attack and
> >I will use their own force or weight to floor them. I believe I can
> >predict what they will say and so have some examples to give to
> >illustrate that EBM is not the monster they believe and that it can
> >help answer questions that arise in general practice.
> >
> >I have never done this before so I wonder if any of you have
> >experience I could benefit from? --
>
> I tend to give a broad historical introduction using examples of
> failure (or delay) in getting research into practice. The examples I
> use are: Lind's work on scurvy, Semmelweiss's work on puerperal fever
> (with the added twist that Oliver Wendell Holmes came to the same
> conclusion, but they were never in contact) then leap forward to CAST
> and thrombolysis (if they thought "of course WE are too sophisticated
> to ignore evidence..."). Then I work through an example of diagnosis
> (exercise ECG for super-fit athlete with non-cardiac chest pain). All
> the time I emcourage discussion. This seems to go down OK - it seems a
> common misconception is still the old one about "cookbook medicine",
> so it's useful to cover ground where preconceptions can be challenged
> ("OK, this 30 year old medical negligence solicitor who jogs every day
> wants a provate referral for exercise ECG and will make a formal
> complaint if you don't comply...what do you do?" -there's always an
> honest one who says "OK, I'll refer - what harm can it do?!!")
>
> Toby
> --
> Toby Lipman
> General practitioner, Newcastle upon Tyne
> Northern and Yorkshire research training fellow
>
> Tel 0191-2811060 (home), 0191-2437000 (surgery)
>
> Northern and Yorkshire Evidence-Based Practice Workshops
>
> http://www.eb-practice.fsnet.co.uk/
Andrew Booth BA MSc Dip Lib ALA
Director of Information Resources and
Senior Lecturer - Evidence Based Healthcare Information.
School of Health & Related Research (ScHARR)
Regent Court
30 Regent Street
SHEFFIELD
S1 4DA
Tel: 0114 222 5420 or 5214 Fax: 0114 272 4095
The author of Netting the Evidence:
http://www.shef.ac.uk/~scharr/ir/netting.html
and Trawling the Net:
http://www.shef.ac.uk/~scharr/ir/trawling.html
E-mail: [log in to unmask]
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