It is good if clinical judgement is undergirded with evidence and a
systematic review can help with this. If someone has done the work and I
can look at the evidence amassed to date in one paper (a systematic
review)I can then go on see if something more recent is out there etc. It
is not a contest between types of research or a grading scheme it is
finding the best evidence in the least amount of time so I am free to
spend that extra time with my patient and know that rather than blindly
following a guideline or target I know what is out there for my patient.
This comment about doing systematic reviews to maintain income??? They
take a lot of time and are not money makers. How much do you think people
get paid for this, as much as practicing medicine? I am profoundly
grateful when I find a review or rapid review that is done well so I donąt
have to do one on the area of interest or sift through other research to
meet the need. It is a public service.
Doctors who fail to use clinical judgment and experience are not
practicing the fullness of medicine and this is not going to be solved by
slamming systematic reviews. This is a confidence, human relationship and
systems mismatch that has nothing to do with a systematic review. A
systematic review can be a tool to help in this process. There are
bridging problems between medicine and social care in some countries(most)
they have independent budgets, this is not the fault of the systematic
review and reviews are not siphoning money from this work.
Best
Amy
On 12/5/15, 5:52 AM, "Evidence based health (EBH) on behalf of Wouter
Havinga" <[log in to unmask] on behalf of
[log in to unmask]> wrote:
>Dear Jon,
>
>My opinion about (the futility) of doing SLRs is that doctors do not do
>what Ian suggests: "to use their own clinical judgment and personal
>experience".
>For example, with reference to SSRIs I believe that doctors are ignorant
>or arrogant to address their own capacities to deal with their own and
>their patient's emotional issues and life events other than giving out a
>tablet. Of course that doctor behaviour is maintained by the wishes of
>the patient for a "quick" fix.
>
>That ineptitude shows in most of chronic disease 'management'. Chronic
>disease is often due to life style issues, but are (out of convenience)
>not managed by the patient nor the health professionals.
>
>No doubt the current established doctor and epidemiology community will
>conveniently keep occupying themselves with SLRs. However, hopefully
>medical education will renew itself and focus on what matters to people
>rather than the shareholders of the pharmaceutical industry.
>
>This article in BMJ Open is hopeful "Medical education and training -
>Junior doctorsą experiences of managing patients with medically
>unexplained symptoms: a qualitative study"
>http://bmjopen.bmj.com/content/5/12/e009593.full
>
>To me it seems that the reasons SLRs are done:
>- convenience (avoid addressing the real (personal) issues
>- to maintain personal income
>
>Best regards,
>
>Wouter (GP - family doctor)
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