Posts Tagged ‘evidence based medicine’
Posted in Cardiology -guidelines, Infrequently asked questions in cardiology (iFAQs), tagged evidence based medicine, guidelines vs recommendatios, instituional protocols, medical ethics, protocols on February 21, 2015| Leave a Comment »
In this era of synthesized evidence base, one of my intellectually aberrant student asked How can we indulge in a popular coronary procedure with class 1 indication backed by level C evidence ? (As defined by the seemingly invincible guideline committee of various International cardiology organizations .)
I told him ,
- Institutional protocols are to be followed
- Guidelines are to be respected
- Recommendations are to be considered
- Please be reminded all of the above can be rejected outright !
Finally , realise Individual decisions based on sound scientific understanding with zero non academic intrusions will be revered forever !
*Caution : If you think you haven’t yet reached that the level of individuality , come what may , you are expected follow these advisories which are primarily aimed at providing quality care and you will be pardoned of any adversaries as well !
Posted in bio ethics, medical quotes, Two line sermons in cardiology, tagged evidence based medicine, flawed drug trials, medical ethics, randomised drug trials, rct, statistical gimmicks on December 21, 2014| Leave a Comment »
After nearly three decades of , treating patients , teaching students and little involvement in research , I have consciously created a new null hypothesis in medical research !
Posted in bio ethics, medical quotes, Two line sermons in cardiology, tagged brainy quotes, cardiology ethics, evidence based medicine, great medical quotes, mahatma gandhi quotes, medical quotes, medical violence, principles of medicine, science quotes, sensible medical practice on November 1, 2014| Leave a Comment »
Mohandas Karam Chand Gandhi , father of my country , India , made these observations in year 1925 about the fundamental constituents of violence in society . These words of monumental wisdom came when he was addressing young Indians in a country- side rally .
Note, his finger points to , what exactly is relevant to our profession ! He emphasized this nearly 100 years ago, when medical science was at its infancy .One can only guess what would be Mahatma’s comment about our profession in it’s current form !
Should we include moral, behavioral and ethical classes right from the first year of medical school along with Anatomy , physiology and bio chemistry.Medical council of India obviously need to burn more mid night oil , I wish it happens in my life time. !
Posted in bio ethics, Cardiology -Mechnisms of disease, Cardiology -Therapeutic dilemma, cardiology -Therapeutics, Cardiology -unresolved questions, medical quotes, tagged art of medicine, cath lab tips and tricks, clinico pathologic conference, controversial decisions in cardiology, coronary care unit decision, cpc in medicine, critical thinking in medicine, emprical medicine, evidence based medicine, experince based medicine, how doctors think, levels of evidence in medicine, medical decision making, medical ethics, medical problem solving, problem solving in medicine, role of medical gudilines, tough decicions in medicine, ward rounds on June 8, 2014| Leave a Comment »
While our brain perceives whatever option we choose is the best for the patient , in reality it is rarely true !
The only comment I wish to make, there is nothing called standard guidelines for complex and unusual problems .We need not be obsessed with protocols !
Please remember , If you apply standard guidelines in non-standard situations 9/10 times we are going to err !
So my choice would be, to go with your gut feeling , of course your gut should be alive , up to date and periodically maintained !
If you don’t have the guts . . . don’t worry you have plenty of other options !
Posted in bio ethics, cardiology-ethics, Land mark articles in cardiology, medical quotes, tagged cad prevention, cardiology practice, cleansing medical literature, commerce based medicine, courage study, emprical medicine, evidence based medicine, ignorance based medicine, lifestyle modification in cad, principles of practice of medicine, randomised controlled trials, rct on November 26, 2013| Leave a Comment »
In one of my meetings , I told a small gathering , that regular exercise can shrink atherosclerotic plaques and regress CAD. I also quoted , a recent large study which has proven this fact convincingly !
I concluded, simple exercise and other life style changes,risk factor correction may convert a 90% lesion to 70 or even 50 % . I stressed the importance of this study and asked my colleagues to avoid misuse of Angioplasties .
When many seemed to agree with me , one angry Interventional cardiologist questioned me, and asked the name of the study, and in which journal it came , What was quality of the paper ?
I told him , It is an Imaginary study done in my back yard . It never got published in print. You may call it as E-journal* , not exactly though.It is not available in any websites , but located in the biological servers, and neuronal circuits as digital imprints in learned brains !
*Journal of experience
You may call it , a scientific forgery , to quote a non-existent study,
“But this study benefits whole lot of my patients”.
He was amused , and became agitated !
He told over the mike , “You are making foolish statement. . . don’t corrupt young minds” !
May be , he is true !
I asked him to be calm and requested to listen to another study which I was about to quote . . .
He couldn’t sit any more and rushed out of the hall !
We are ready to believe all those rubbish stories about a fourth generation self disappearing BVS that is able to scaffold a coronary artery and maintain a MLD by 2.5mm and TVR by 20 % and prevent near MAZE at 30 days by 9 % and improve long term survival by 6 months at the cost of 100, 000 Rs per month .Only to realise, it may be a farce . . . 5 years down the lane !
How to cleanse the darkened face of science ?
When falsehoods come with evidence and harm people , Good deeds can be preached without evidence to save our fellow human beings !
Posted in bio ethics, cardiology journals, Cardiology quotes, cardiology-ethics, tagged ebn, emprical medicine, ethics in medicine, evidence based medicine, favorite medical quotes, hippocrates, randomised control trial on June 14, 2012| Leave a Comment »