Thanks as always to the group for postings.

 

We tried to cover some of the questions posed by Amit in the last paper of our series of 5 last year. I won’t post all 5 again – here’s the last one Amit. Hope it helps.

 

As for the specifics – I work lots with pharmacists and wouldn’t have it any other way. I agree with Ben’s description of the traditional model of the pharmacist assisting with technical knowledge and the clinical decision making resting on the ward round largely with the senior clinician. However, there’s also the radical (to some) approach here in the UK where we now have non-medical prescribers working within their competence in clinical roles where they can prescribe autonomously after additional training. It’s been fascinating to see some of those individuals (largely nurses and pharmacists) recognising the decision making issues under uncertainty and then developing their skills to meet those challenges. It looks like this isn’t a role for every nurse or pharmacist, but for those with the motivation, skills etc ……well, there are clearly some highly competent non-medical prescribers already. And then ‘in between’ those two roles, we have lots of pharmacists working as “knowledge officers” – doing a role similar to academic detailing. I’m sure these three models are just the tip of the iceberg.

 

Amit, for me EBM is definitely not about having a Masters or a Doctorate. I recognise that sometimes its important to have that piece of paper which opens doors, but it’s possible to make lots of progress and carve out a very satisfying career without. It’s largely about an attitude, a few skills to understand a summary of evidence, and then managing to flow of information based on the best available evidence into decision making. Sure there’s a need for the producers of e.g. systematic reviews to have great methodological skills to continually improve the quality of the information provided. But I suspect we’d improve the quality of care for a population quickest if we were to concentrate on summaries of evidence for common conditions and make sure we were using that best evidence (moderated by circumstances and wishes) more often than we sometimes seem to do currently.

 

I know lots of people who are members of this group run workshops in developing countries – is it time to distil articles such as this http://ebm.bmj.com/content/5/4/100.extract into e.g. a seminar? Apologies if that’s already been done.

 

Best wishes