Badri raises a great question about the dilemma between quality of evidence
and questions about the quality of the source of evidences. I think when we
validate a study or a piece of research on the basis of its design, its
patient selection and deselection criteria, methods, and the results
obtained, we tend to validate the study/observation on the basis of the
quality of evidence presented.
When a physician asks another colleague passing evidence based opinion,
whether he is experienced with the particular procedures, it is questioning
the validity of the source of this evidence. What is the true correlation
between perceived quality of the source of evidence (based on the
educational background of the presenter, teaching or research experience,
clinical skills, departmental affiliation etc...) and quality of evidence
presented? Are specialists more likely to practice evidence based medicine
in their respective fields? Are generaliasts more likely to adhere to EBM?
Does it depend upon the years of experience each one has in the specialty?
Donabedian's article on quality of care comes to mind where he analyzed the
physician attributes and quality of care processes, but similar studies on
adherence to evidence based medicine would be equally interesting, I guess.
I believe there is no one way to satisfy the person who might like to know
how many amebic liver abscess was relieved by the presenter, unless a strong
evidence exists to refute him. The difference between these two issues may
be highlighted in the beginning of the presentation, for whatever it may
worth.
Arin
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