Preamble
Hey dudes, will you stent this 76 year old fragile man’s Aortic valve ? It looks shaggy and it seems to be leaking as well.Iam not sure its really tricuspid or not .It is so distorted . By the way , he also has a left main lesion with no protection.What shall we do ? Will the Jena valve do the trick ? My experienced collegue threw this question to a flock of freshly hatched senior residents of a upscale cardiac center.
After rapidly feeding the necessary risk predicting numericals, clinical and hybrid imagery data , they dug deep into the iOS-powered gadget, loaded with latest TAVR app fused with SYNTAX 2 and FAME 2 overlay for few minutes and started responding one by one.
Yes sir , no Issues, we can comfortably stent it , Its class 2 A / with level B evidence according to JACC intervention article, but, I must say , it was class 2B just a month ago. Another fellow interfered, no sir, ESC says it’s still class 3 but the evidence is C so I am not sure how to interpret it. The third fellow who usually is a quiet guy, came up with this, but sir, It seems TCT and EURO-PCR has just released an update, the indication is currently upgraded to class 1 backed by level A evidence .
Are you talking about TAVR or Left main? the confused consultant quipped… that’s EBM at its best !
Evidence-based errors in cardiology
Evidence is the most sacred word in current medical practice. How much of our practice is evidence-based ? It is considered as a quality check. But, today we harshly understand, the evidence to which our conviction clings has a very short expiry date. Apart from expiry , the evidence thing comes with serious invisible manufacturing defects as well. It may become null and void even before its fully disseminated into the patient domain.(Please mind, your patient’s life is tied to this clueless evidence !)
So, how to tackle this dangerous dissemination of premature wrong evidence from injuring the patient ?
We don’t have a definite answer . . . except to say, use the available evidence carefully and cautiously. If necessary (it will often be) throw it to the nearest dustbin by your own evaluation assisted by intuition, and a liberal dose of learned empiricism. Mind you, to do this you must be blessed with enough knowledge, wisdom, and courage as you need to overcome strong pressure to do the opposite.
My prediction is, bulk of the future problems in medicine would come from failure to dispose evidence based errors in medicine.
Dr.S.Venkatesan MD 