I've called this EBM is bullshit part 2, because I've lamented both personally and via email to many about how much I have come to hate EBM. Evidence-Based Medicine.
I find it tedious when rounding back home to discuss which drug, if used in 1.5 billion people is likely to save an additional 3 lives, and was the study well designed, blah blah blah. Let me puke. This doesn't mean I don't practice EBM. I want to be a good doc, so I'll look up the most recent study to see which drug/treatment/witch-doctor potion is best for "X" condition. But I'll also adapt a herd mentality, and do what my colleagues do, and more importantly, what the insurance will pay for... (No use prescribing a novel drug is it cost too much for people to afford).
There is nothing sexy about the mental masturbation of EBM... There isn't really much sex in medicine, contrary to what the TV shows portray. What is sexy though, is when on rounds, the pathophysiology of a condition is explained, when parallels are drawn to other diseases, then the lab results etc are correlated with what's happening at a cellular/tissue level. We're talking medicine in a bikini or thong sexy here. (Aside: Medicine seems to have a lower population of people who would look great in a bikini or thong. There's some irony to that).
I have visions of rounding back in the US were we all pull out our tools (palm pilots!), somebody gets on-line and we debate if 1 or 2 mg/kilogram of prednisone is best for the treatment of a pedi asthma exacerbation (who fucking cares cause the kid will likely spit out part of it, part of it will spill when the jar is opened, and it'll be forgotten on 2 days)...
Rounding here, there's no debate on this crap, there's discussion of why thy kid with nephrotic syndrome has an elevated ESR... (GROAN-what's the evidence behind the usefulness of ESR in the diagnosis of Nephrotic Syndrome-I can HEAR that question being asked by EBM Fans)... There's a 20 minute discussion of using the history to help figure out if an infant with jaundice has a pre-hepatic, intra-hepatic, or post-hepatic problem, and a conversation of what on the clinical exam will rule-in, or rule-out which congenital infection!
Don't get me totally wrong, I am fully aware of the utility of EBM in advancing medicine, but sometimes I just have to think that it's at the expense of the sexy part of medicine...
