Subject: | | Re: Question answering |
From: | | "Toby Lipman 7, Collingwood Terrace, Jesmond, Newcastle upon Tyne. Tel 0191-2811060 (home), 0191-2869178 (surgery)" <[log in to unmask]> |
Reply-To: | | Toby Lipman 7, Collingwood Terrace, Jesmond, Newcastle upon Tyne. Tel 0191-2811060 (home), 0191-2869178 (surgery) |
Date: | | Fri, 5 Nov 1999 00:03:55 +0000 |
Content-Type: | | text/plain |
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In message <[log in to unmask]>, Jonathan BRASSEY
<[log in to unmask]> writes
>some health 'officials' here in Wales...
>are of the opinion that only health professionals can answer their
>own clinical questions (irrespective of time pressures, searching
>skills etc.) as only they know of the context etc. They believe that
>third parties are incapable of answering other people questions.
>
>This to me seems a ridiculous position as I regularly answer
>questions on behalf of GPs - and they always seem happy with the
>answers I give. However, I am struggling to put together a counter-
>argument, any ideas of how I should structure such a response?
>
Third parties can certainly answer questions about the evidence for or
against the use of particular interventions in particular conditions.
This is what they do in a systematic review or in formulating an
evidence-based guideline. I do have doubts about them linking treatment
recommendations to the evidence except in the most general way ("the
options are..." "strength of evidence level...") as I believe that
context is central to assessing the *applicability* of evidence to an
individual. In general decisions about whether an intervention should be
used in an individual patient depend not only on the evidence, but on
the clinician's knowledge of the patient's circumstances, on the
patient's views and on the clinician's context-specific clinical
judgement. It would therefore be reasonable for a third party to find
evidence about the effectiveness of ACE inhibitors in treating left
ventricular failure and to critically appraise it for validity, but not
reasonable for the third party to advise a clinician whether ACE
inhibitors should be used in an individual patient.
Toby
--
Toby Lipman
General practitioner, Newcastle upon Tyne
Northern and Yorkshire research training fellow
Tel 0191-2811060 (home), 0191-2437000 (surgery)
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