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Overcoming Bias Commenter's avatar

Nope, I know it doesn't happen on a large scale. It doesn't even happen in the academic medical center where I practice, at least much of the time. Just read the article quoted in the other EBM thread about Dan Merenstein if you have any doubts...but since my job is to convince medical students that they need to practice that way, all I can do is point them in the right direction. Introduce them to evidence-based clinical guidelines, teach them how to critically read and be skeptical...the fact is, right or wrong, that variability in practice may be disappearing for the wrong reason...through issues of managed care and cost control. But decreasing the variability of practice patterns, using the Dartmouth index effectively, and paying attention to current literature will improve the quality of medical care. It's the "one day" I'm aiming for...but I do believe that the situation has improved a great deal in the 25 years I've been teaching. In my course we use small group teaching for half the content, reading current articles. Among my small group teachers are the head of the lung transplant program, the division chief of GI, a former dean of the medical school, the department chair of family medicine, and assorted hematologists, rheumatologists, a urologist, and a medicine chief resident. Not one of these teachers have had formal training in EBM....they all are committed to critical reading of the literature and implementing it in their practice. That has an effect on students regarding the relevance of the content. I frequently have graduates come up and tell me that they have continued reading in their practices. I think things are changing.

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Overcoming Bias Commenter's avatar

I'm sorry, were you laboring under the impression that the actual practice of medicine by physiciansis based on science, evidence, and empirical thinking? That would be a revolution. In practice,what a doc does to determine how to treat a patient does not involve a hardcore look into the dataor results of the clinical studies. I mean, there's some communication pipeline that tells docs howthey should diagnose things and treat things under certain circumstances, but it is not a criticallens around the clinical trials. Did you really think that that happens on a large scale? Are youjoking? Maybe one day.

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