Wednesday, December 20, 2006

Who needs medical knowledge, anyway?

In a recent MedGenMed Video Editorial Dr. Hampton Roy, Assistant Clinical Professor of Ophthalmology at the University of Arkansas for Medical Sciences said: “As physicians, we do not need to carry information about lab tests, medications, or dosages in our heads. We need a reliable ready source of information to consult……” With apologies to Rush Limbaugh, stop the tape! What does he mean, we don’t have to carry information in our heads? Sure, we make no pretense of knowing it all, but don’t we need to know anything? I guess not, in the minds of some. After all, we can just “go look it up.”

And what would that mean for the medical school curriculum? Just turn students loose with lap tops, subscriptions to Up To Date and lots of patients, I guess. Don’t laugh. It’s not far from a proposal in BMJ a few years ago in which the medical school of the future would train doctors primarily to be information hunters, eliminating lectures and exams in anatomy, biochemistry and physiology.

Dr. Roy believes patients can help close the resulting knowledge gap. Referring to the “reams of paper” patients often bring for their appointments he says: “Since we are now ‘partners’ with the patient in terms of diagnosis and treatment, we need to honor the patient's book of knowledge and provide our best guidance system.” But many patients, 44% in this study, have no desire to seek out medical information for themselves. Of those who do, few have the skills in literature searching and critical appraisal needed to apply the principles of evidence based medicine (EBM), without which clinical decision making becomes flawed. The task of making patient decisions evidence based is onerous, as I once blogged here. Although patients often bring their homework to the clinical encounter I’ve yet to be presented with a rigorous, critically appraised summary of the best evidence. If only it were so! More often I’m presented with a drug ad or the latest New York Times article---hardly evidence based.

1 comment:

davidp said...

I agree. Genuine anatomy knowledge is useful and I don't think the information browsers can do it yet.

Eg. The top of my daughter's left little finger was painful. My (old fashioned trained doctor) father heard my description and immediately said 'the nerve running around elbow can produce hypersensitivity there from pressure on the elbow.' I knew (he didn't) she had been reading propped up on her elbows. Changing posture promptly fixed the problem. How long would it take to find that anatomical information from a web search ?