At 18:50 26/08/2007, you wrote:
>Julian
>What hits me about this debate---what tests should be done if any---is
>that we, while trying to be rigorous about it, are ending up confused as
>to why we are testing.
>Easier to give an example;
>someone on statins and/or quite overweight and/or on a SSRI may have
>abnormal LFTs, probably mildly, and for no other reason.
>
>Should we do the LFT in the first place?
Very reasonably you've looked at step one.
However the debate seemed to be about step 2: the patient who, for
whatever reason, has had LFTs done and found to be abnormal.
The consideration of when LFTs need to be done "ab initio" is
probably too big a debate for here.
The only "philosophical" point I'll make is that the investigation of
patients who have an illness or condition is NOT the same as pulling
people off the street for a screening test.
Many of the principles may apply, but cannot entirely be "taken for granted".
EBM is a uesful guide, but it should not become a straightjacket. I
"believe in" EBM, but good medical care has always gone well beyond
and outside what is evidence based, and the principal advantage has
not been that patients lived longer but that they felt cared for.
That still seems to matter.
Of course this is just one point of view... no doubt there are others?
Julian
|