> I think there is another very important aspect of medicine which often
> gets lost in the usual discussion of EBM but is inherent to how patient
> percieve our care and match it with their expectation. Patient's
> expectation seem to be guided by their perceived vulnerability to illness,
> past experience with health providers and acquired knowledge about their
> illness.
> A recent supplement on Symptom Research in 'Annals of Internal medicine
> 2001;134:801-930 ', describes in a series of articles the challenge's of
> providing medical care under current circumstances.
>
> I would appreciate if some one could direct me to a questionnaire or
> instrument tool which would point particularly to patients expectation
> from their
> physician visit or patient anxiety score prior to physician visit.
>
> Amit K. Ghosh, MD, FACP
> Division of General Internal Medicine
> W-17B
> Mayo Clinic
> 200 First St. SW
> Rochester, MN 55905
> Phone: 507-538-1128
> Fax: 507-284-4959
>
> From: James M. Walker M.D.[SMTP:[log in to unmask]]
> Reply To: James M. Walker M.D.
> Sent: Tuesday, June 05, 2001 2:00 PM
> To: [log in to unmask]
> Subject: Re: Is EBM Effective?
>
> Preston,
> It must be much more complex than this.
> What if an excellent RCT is three years and has not been superceded by
> better evidence?
> What if an observational study provides the best available evidence
> regarding the treatment of a disease that is fatal untreated?
>
> Jim
>
>
> Optimized information in the nick of time.
>
> James M. Walker, MD
> Assistant Professor, Medicine
> Senior Clinical Information Architect, Information Resources and
> Technology
> Center for Informatics
> Hershey Medical Center
> P.O. Box 850, A-310
> Hershey, PA 17033
> [log in to unmask]
> 717 531-1594
>
>
> >>> preston <[log in to unmask]> 06/05/01 10:58AM >>>
> RCT less than 24 months old.
> --
> Preston H. Long
>
> > From: "Djulbegovic, Benjamin" <[log in to unmask]>
> > Reply-To: "Djulbegovic, Benjamin" <[log in to unmask]>
> > Date: Tue, 5 Jun 2001 08:41:27 -0400
> > To: [log in to unmask]
> > Subject: Re: Is EBM Effective?
> >
> > But, how do you define "the most current and up to date info"?
> > ben
> >
> >
> > -----Original Message-----
> > From: preston [ mailto:[log in to unmask]]
> > Sent: Tuesday, June 05, 2001 8:32 AM
> > To: Djulbegovic, Benjamin; [log in to unmask]
> > Subject: Re: Is EBM Effective?
> >
> >
> > To me an EBM provider uses the most current and up to date info in his
> > practice. I find reasons why providers don't use EBM far more
> interesting.
> > Some reasons offered have been ignorance, peer pressure, financial
> incentive
> > and reward. William J. Mayo said,"The best interest of the patient is
> the
> > only interest to be considered." I am currently involved in a study
> > comparing EBM to placebo and conventional treatments of a condition.
> > --
> > Preston H. Long
> >
> >> From: "Djulbegovic, Benjamin" <[log in to unmask]>
> >> Reply-To: "Djulbegovic, Benjamin" <[log in to unmask]>
> >> Date: Tue, 5 Jun 2001 08:22:13 -0400
> >> To: [log in to unmask]
> >> Subject: Re: Is EBM Effective?
> >>
> >> Since there has been some lamenting recently about the lack of activity
> on
> >> this group, to add some "fuel" (pointing to the difficulties if not
> >> impossibility of conducting a study proposed below), I would just like
> to
> >> ask:
> >> "how would one define an "EBM doctor"? Let's say someone would like to
> > fund
> >> such a study: What definitions of EBM vs. non-EBM doctors would you
> use?
> >> (Actually, I am not trying to be a provocative here. It is just after
> many
> >> years of teaching and hopefully practicing EBM, I came to conclusion
> that
> >> the value of EBM should not be evaluated against non-EBM, but should be
> >> sought in the understanding of the quality of our knowledge, as I
> > described
> >> in my message from yesterday).
> >>
> >> hope we can get some stimulating discussion going...
> >>
> >> ben
> >>
> >> -----Original Message-----
> >> From: jordanra [ mailto:[log in to unmask]]
> >> Sent: Tuesday, June 05, 2001 7:01 AM
> >> To: [log in to unmask]
> >> Subject: Re: Is EBM Effective?
> >>
> >>
> >> Agree with what has been said, but would add, that EBM might also
> assist
> > in
> >> building more realistic expectations into the physician/patient
> > relationship
> >> and medical science. A major challange however, is for physicians to
> >> develop the necessary communication skills. (And to some degree, for
> the
> >> average patient to develop some educated listening skills).
> >>
> >> R. Jordan
> >> LTC, MC
> >> Commander
> >> U. S. Army Medical Activity, Japan
> >>
> >> ----- Original Message -----
> >> From: "Marjan Kljakovic" <[log in to unmask]>
> >> To: <[log in to unmask]>
> >> Sent: Tuesday, June 05, 2001 7:01 AM
> >> Subject: Re: Is EBM Effective?
> >>
> >>
> >>> I read with interest the angst around trying to see whether teaching
> >>> EBM is effective on patient outcomes. I think Toby Lipman hit the
> nail
> >>> on the head when he wrote
> >>> "Surely using patient outcomes is a far too complex end-point for a
> >>> study of the effectiveness of EBM?"
> >>>
> >>> The issue of compexity is pivotal in understanding why the
> >>> effectiveness of EBM teaching will be ellusive.
> >>>
> >>> The core of activity in general practice (for doctors) is the doctor
> /
> >>> patient / illness relationship. EBM is a technique used by the doctor
> to
> >>> try and influence that relationship so that a desired outcome might be
> >>> achieved with respect to an illness.
> >>>
> >>> As a teacher of EBM with undergraduate and post graduate medical
> >>> students, I live in the hope that I have an effect on patient
> outcomes
> >>> which those students will create with their future patients. I use
> the
> >>> word "hope" because I am sure that what I teach is at least two steps
> >>> back from any patient outcome:
> >>>
> >>> I would encourage research into the various relationships that are
> >>> inherent in the steps between the teacher of EBM and the desired
> >>> outcomes. We need more qualitative research to answer questions
> >>> on relationship issues such as
> >>> "How can teachers influence students to take EBM seriously?"
> >>> "How do student carry EBM teaching into clinical practice?"
> >>> "How do patients perceive the "EBM" doctor" compared to the
> >>> "non-EBM doctor?"
> >>> Cheers
> >>> Marjan
> >>>
> >>>
> >>> The whole matter is complex because we need to understand that
> >>> there is
> >>>
>
>
|