thanks, Felice
it appears from your and other response that it is content (and context) that matters. This is probably a reason why people do not consult guidelines outside their fields. This is certainly true for me: I rarely consult guidelines outside of my field, while I do consult hem-onc guidelines often (even those that I helped develop!) particulary when I want to deviate from the guideline. Time is a key factor, since I am so familiar with guidelines in my own field and I can find what I am looking for within 1-2 minutes, while it would probably take me 20-30 minutes to understand/consult the guideline outside of my own specialty. I should also mention that (outside giving cancer-specific treatments and some other treatments that are outside of purview of generalists, e.g. treating hemophilia...) >90% cases in which I am asked to give second opinion/consult relate to providing information/evidence to the questions requested in the referrals. Since all available information to me are equally accessible to anyone else ("there is no secret knowledge in medicine"- I often tell to the referring docs and patients alike), in theory docs could just dial EBM services and get the answers to the questions asked? But such services will be devoided of the context/content. So, ultimately content will always win...I think what EBM movement ought to do is to re-focus effort from generalists and consumers to train suspecialists ("experts") in EBM methods...
ben
________________________________________
From: Evidence based health (EBH) [[log in to unmask]] On Behalf Of [log in to unmask] [[log in to unmask]]
Sent: Wednesday, September 02, 2009 6:01 AM
To: [log in to unmask]
Subject: Re: EBM and increasing requests for the use of consultants...
Hi Ben and Others,
Very interesting discussion here.
I think that evidence based guidelines are not easy to develop and use. That's why Ebguidelines production is not in CME and educational programs for health care workers. EBguidelines need to be continuously updated and adapted. More over there is no interest in health care managers and directors to use Ebguidelines adopted in real practice as evaluation criteria for physicians, consultants, referrals and so on. Is there no trust about Ebguidelines use is correlated to better outcomes for patients?. There is no clear policy about this.
So i do not think EBM rising (as EBguidelines use in real practice) can justify requests of the use of "experts" . It is true the contrary.
Felice Musicco
Hospital Pharmacist in Rome, Italy
www.ifo.it
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From : "Evidence based health (EBH)" [log in to unmask]
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Cc :
Date : Wed, 2 Sep 2009 08:09:21 +0530
Subject : Re: EBM and increasing requests for the use of consultants...
> Forwarding this message from Scot who is unable to register for this list
> but is responding to the discussion:
>
> Rakesh, I probably cannot post to the EVIDENCE-BASED-HEALTH group, so please
> pass this along:
>
> *The need for information is often much more than a question about medical
> knowledge. Doctors are looking for guidance, psychological support,
> affirmation, commiseration, sympathy, judgment, and feedback. This
> "information need" is particularly poorly explored
> *
>
> I strongly agree with the above passage, find it quite novel and apropos,
> but foresee even greater difficulties "selling" this information need to the
> IT and finance personnel who generally control information tools in the
> enterprise. For example, at the link below is what occurred at one of the
> largest pharma research labs in the world, where selling the idea that drug
> discovery scientists needed the best informatics tools fell flat. Not
> intuitive, but that's the way it was.
>
> See:
>
> "Sure path to R&D failure: Conflation of IT with information science in the
> pharmaceutical industry"
> http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=pharma
>
> Scot
>
> --------------------------------
> Scot M. Silverstein, MD
> Consultant in Medical Informatics
> Teaching faculty in Healthcare Informatics and IT (Sept. 2007-)
> Director, Institute for Healthcare Informatics (2005-7)
> College of Information Science and Technology
> Drexel University
> 3141 Chestnut St.
> Philadelphia, PA 19104-2875
>
> Email: [log in to unmask]
> Bio: www.ischool.drexel.edu/faculty/ssilverstein/biography.htm
> Common Examples of HIT difficulty:
> www.ischool.drexel.edu/faculty/ssilverstein/medinfo.htm
> ARS KU3E, member www.arrl.org
> ________________________________________
>
