You make a very valid point. We are seeing both backlash and bandwagon,
both equally destructive to efforts to truly teach physicians to take an
evidence-based approach to the care of patients. I am constantly asked to
"Teach us evidence-based medicine" in a 1 to 2 hour time slot, between
rubber chicken and a drug rep presentation. No thanks.
On the other hand, I think the "marketing" of EBM is very important, and I
always begin courses with about an hour (or more) of pure marketing. You've
got to convince folks that there is a problem with the way things are done,
with the way they choose interventions, and with their own powers of
observation, before they are ready to open themselves to a different
paradigm. My wife is on the faculty here at MSU in Labor Industrial
Relations, and she would rather talk to a roomful of drill press operators
and union negotiators than to a group of doctors. No question! And she has
done both...
Mark
Mark Ebell, MD, MS
Department of Family Practice
Michigan State University [log in to unmask]
Helping Physicians Become Medical Information Masters
http://www.infopoems.com
> -----Original Message-----
> From: Katherine Schneider, MD [SMTP:[log in to unmask]]
> Sent: Wednesday, June 09, 1999 4:32 PM
> To: Evidence-based-health
> Subject: EB-CME marketing?
>
> Dear all,
>
> I was reminded of this by the posting on the EB-Oncology conference -- and
> I know nothing about that particular meeting so please don't take this as
> directed towards it.
>
> My hospital recently consulted me about the advisability of sending one
> member of each Obstetrics group to a nearby day-long conference entitled
> "Evidence-Based Obstetrics" sponsored by a nearby medical center which
> does a large volume of CME. I looked at the program and the topics
> looked like ones that would lend themselves well to EBM-type discussions.
>
> The actual content turned out to be very disappointing, and probably did
> significant HARM in terms of promoting EBM approaches among our OB's, one
> of whom told me once that "EBM cannot be done in OB because the only
> outcomes are a dead baby or a dead mother". Essentially, most
> presentations were the same old "review of the literature" by an expert
> repackaged as "EBM". I think the word "meta-analysis" was mentioned
> once. Likelihood ratio was mentioned once in the context of promoting a
> new test, though nobody explained what a LR is. There was a brief
> introduction on the definition of EBM by a perinatologist who clearly had
> limited familiarity with EBM and focused on its limitations. The most
> appropriate and stimulating discussion (I thought) was by a general
> surgeon talking about the quantitative risks and benefits of treating
> gallbladder disease in pregnancy. I rolled my eyes to the point of
> vertigo at the number of times the speakers said, "Well, the
> evidence says do this, but in reality I do that". Anything even
> approaching the concept of NNT, or the Cochrane Database -- forget
> it!
>
> I'm concerned about the proliferation of "EB-CME" courses, and how we
> "local experts" can help our colleagues pick out the ones that are truly
> based upon principles of EBM/EBHC, versus those that throw the phrase
> into the title in order to market the program. Should we
> internationally trademark the phrase and accredit CME courses that wish to
> promote themselves as evidence-based? (Only 95% joking on that one).
>
> I'd be curious to hear others' experiences. I feel that I got a bit
> burned on this one, and I'm certainly going to be extremely careful in
> the future in endorsing anything as evidence-based until I know the
> details. Sorry for the long venting message!
>
>
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