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Medicine: humanly impossible?

My wife is studying Physiotherapy and spends her life scouring publication databases on-line. If she proposes a regime of treatment to a lecturer they ask: “How do you know? Where is your evidence?” Excellent, I say as an inveterate sceptic.

Both Shahid Shah and Dale Hunscher have posted on Evidence Based Medicine (EBM). Shahid has posted slides from a presentation, and Steve Beller makes some particulary interesting comments at the end of Dale’s entry.

I’m not sure that I would entirely agree with Dale’s comment: “It's about getting all relevant facts in front of the clinician at the point of care and then trusting her to use her own judgment as to how the facts apply to the situation at hand.”

I more inclined to agree with a quote I saw in a presentation on Artificial Intelligence in healthcare: “Medicine is a humanly impossible task.” The estimated rate of medical adverse events in the US and in the UK would seem to support that view.

Integrating EBM and healthcare IT is an exciting prospect. This article: Assessment of the potential impact of a reminder system on the reduction of diagnostic errors: a quasi-experimental study concludes in support of the use of ISABEL to support clinical decision making.

However, as usual, technology will be a small part of the challenge. Experience so far indicates that disciplinary boundaries, differences in the interpretation of evidence and general reluctance (or inability) to change practice owing to the pressure of business-as-usual are likely to be more potent factors.

To make progress healthcare must adopt change and continuous improvement as givens and move away from a static, authority-driven approach.

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I read Colin Jervis' post Future Health IT: Medicine: humanly impossible?, a response to an earlier post of mine regarding technology supporting evidence-based medicine. Colin says we disagree, but I'm not seeing where, so I have to disagree that we di... [Read More]

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