I would agree--and speculate that the cardiologist did not risk-stratify
the patient for risk of a fib and for her risk of bleeding on warfarin (for both
of which there is high-quality evidence). She and her primary doctors may have
sensed this omission at some conscious or semi-conscious level.
So I would speculate that the cardiologist's recommendation was not fully
evidence-based, in addition to flouting the patient's autonomy.
James M. Walker, M.D.
Chief Medical Information Officer
Geisinger
Health System
[log in to unmask]570
271-6750
Internal Mail Code 30-06
>>> "k.hopayian"
<
[log in to unmask]> 11/10/02 03:08AM >>>
A recent
paper in the BMJ sets up a false opposition between EBP and the
consideration
of patient values and beliefs.
BMJ 2002;325:1018-1020
( 2 November ) Clinical review Integrated narrative
and
evidence based case report. Case report of paroxysmal atrial
fibrillation and
anticoagulation
Reis et al
http://bmj.com/cgi/content/full/325/7371/1018The
authors state "This paper tries to bridge gaps between a patient's
and
doctor's narratives and the evidence."
The authors describe how
they listened to their patient and helped her to
arrive at a decision not to
take warfarin after a cardiologist had
recommended she take it for AF.
Reading their report, it seemed to me that
the patient had had a
dysfunctional consultation in which she felt that her
feelings and beliefs
were ignored. It is fallacious to go from the fact that
there is evidence
favouring the use of warfarin in AF to the belief that you
should use
it and then to go on to wield this belief as proof that EBP
dictates
what patients should do.
--
Kev (Kevork) Hopayian
GP, The
Surgery, Main St, Leiston, Suffolk, IP16 4ES, England
Tel +44 (0)1728
830526
Fax +44 (0)1728 832029
