Monday, April 18, 2011

Statistical Regression, MD

The Science-Based Medicine blog has an interesting post about the role of experience in medicine:
Before we had EBM (evidence-based medicine) we had another kind of EBM: experience-based medicine. Mark Crislip has said that the three most dangerous words in medicine are “In my experience.” I agree wholeheartedly. On the other hand, it would be a mistake to discount experience entirely. Dynamite is dangerous too, but when handled with proper safety precautions it can be very useful in mining, road-building, and other endeavors.
 I don't think describing experiential expertise and intuition as risky-yet-rewarding medical strategies fully appreciates the historical trajectory of evidence-based medicine. While it's true that deep personal experience and intuition in doctors is currently essential to their provision of healthcare, computerized medical records and new diagnostic algorithms will soon change what medical services doctors provide. With the possible exception of new surgical techniques, doctors are no longer in the business of developing treatments or evaluating what works and what doesn't (biostatisticians are the great unsung heroes). Data-crunching, made possible through computerized records, will once again begin to encroach on a realm currently under doctors' jurisdiction: diagnosing ailments. Atul Gawande's checklist idea goes a step further, identifying healthcare implementation (even down to specific details like hand-washing) as another area being systematically blighted by decisionmaking driven by "experience," intuition and routine. The information revolution is changing what doctors do by enforcing precision and rigor, in the process saving millions of lives. This is all very good for humanity, but possibly not not for young med school students salivating about their future social cache. But I'm sure providing a nice bedside manner to patients is one duty that won't be disturbed by computer innovation. Although...

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