At 12:05 AM 1/21/04 +0000, Toby Lipman wrote:
>Amit is entirely correct in identifying the problem - that physicians
>(and other clinicians) do not understand probability and cannot explain
>its consequences. Every now and again I re-read the introduction to
>"Clinical Epidemiology: a basic science for clinical medcine", where
>Dave Sackett observes that "it dawned on him that applying these
>epidemiologc principles (plus a few more from biostatistics) to the
>beliefs, judgements and intuitions that comprise the art of medicine
>might substantially improve the accuracy and efficiency of diagnosis and
>prognosis, the effectiveness of management..." etc.
>
>The point is that understanding these principles and being able to
>explain them are fundamental skills that are required for clinicians who
>claim to practice EBM. Unfortunately, the lack of such skills among most
>clinicians has led to EBM being seen as the same as the implementation
>of research findings, and to the choice of what research to implement
>and how it is to be done being left in the hands of the pharmaceutical
>and guidelines industries.
As someone who has been involved in research in this area now for 20+
years, it seems to me that physicians are willing to address their own
problems in understanding probabilities and making probabilistic judgments.
Moreover, medical students, especially in their clinical years, are also
willing to think about these issues.However, in the US, as clinicians
become increasingly harried, harassed, and dispirited, they are less likely
to be wiling to devote their time to this issue.
Bigger questions are why we have made so little progress incorporating
these issues, and more broadly, EBM and medical decision making into
medical education, and why it is still so hard to get research in this area
financially supported.
...............................................................
Roy M. Poses MD
Director of Research, General Internal Medicine
Brown University Center for Primary Care and Prevention
Memorial Hospital of Rhode Island
111 Brewster St.
Pawtucket
RI 02860
USA
401 729-3400
fax 401 729-2494
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