Wednesday, February 06, 2008

An attending's perspective on information in medicine

This week’s JAMA has an interesting piece written from the perspective of an attending physician, considering how the role of the mentor in clinical medicine has evolved with increasing availability of information (mentions PDAs, UpToDate, PubMed, among other things).

An excerpt:
It has become increasingly clear to me that with the information revolution in full throttle, the role of the clinical attending has changed drastically and continues to evolve. Besides using rounds to discuss many of the social, ethical, and professional issues surrounding a patient's care, I increasingly find myself teaching less about the current state of information and more about how things have changed and how our understanding of an illness or treatment has evolved to where it is currently. I teach about multiple portals—how there is no single way to approach a case and how the one we choose may not be the only or even the best strategy despite our attempts to get the facts right and review the relevant data. I have the distinct impression that my mentors possessed a degree of certainty that in hindsight I am not sure was warranted. In this era of evidence-based medicine, I am more likely to point out how scanty the evidence actually may be when making a decision. Although I may refer to the "classic" article in a particular field, all too often I will point out how in retrospect it looks much less convincing than when it was first published just 10 years ago. Rather than giving my team answers, I am more likely to ask them to formulate a question that interests them regarding a specific case, then investigate the data, and report back to the group. The group can then try to digest this information and place it in the context of the case at hand.
Reference:
Horowitz HW. The Interpreter of Facts. JAMA 2008;299: 497-498.

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