Jon Brassey wrote:
> A busy clinician has a limited amount of time to answer a clinical
> question. They carry out a quick search and find 5 decent abstracts.
> They have two options:
> 1) Look at one full-text article.
> 2) Look at 5 abstracts.
> Which do people think is preferable?
First it helps to remind ourselves what the problems are with reading
just the abstract.
1. The abstract may not clearly state information about how the data was
collected (e.g., blinding) or how the data was analyzed (e.g., intention
to treat analysis) that you would need in order to properly evaluate the
strength of evidence.
2. The abstract may focus on the wrong outcome measure. The abstract
may, for example, only include details about the outcome measure with
the small p-value rather than the outcome measure that is important from
the patient's perspective.
3. The abstract may not clearly state the risks of the treatment
preventing you from assessing the cost-benefit ratio.
4. Sometimes the abstract just flat out gets it wrong. It states
something that is contradicted in the full text of the paper.
In spite of this, I would argue that a busy clinician has to trust the
system. Some abstracts are misleading, but the time lost verifying
whether the contents of the abstract are a fair representation of what
appears in the article itself is too big a price to pay, if the
clinician is truly as busy as you say.
Reviewing the abstracts has the extra benefit of assessing the
robustness of a finding across different patient populations and
different research designs.
Besides, if you wanted to choose intelligently which among the five
articles you had to read the full text of, you'd have to read the
abstracts anyway. <grin>
Of course, we need to train clinicians in rapid critical appraisal and
speed reading so that they can learn to read the full text of five
articles in the time it used to take to read five abstracts. Some
teachers of EBM advocate not handing out papers in advance, but making
students read the papers in class so that they are forced to read
quickly and hone in on the important details.
Alternately, the health care organization that employs the clinician
should supply the appropriate resources through the library to allow
someone to offer a critical appraisal of the full text of these five
articles to a busy clinician on short notice.
--
Steve Simon, Standard Disclaimer.
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