Tuesday, May 12, 2009

Writer's block

Here I am sitting at my computer trying to write a review on MRSA in the intensive care unit, and all of a sudden I cannot write -- everything is distracting me, I cannot figure out what I want to convey, or how I should structure the paper. This may well be a manifestation of information overload. When I type "MRSA" in the search engine PubMed, I get 12,214 hits! When I narrow it to "MRSA+ICU", it becomes a much more manageable, but probably not particularly comprehensive and still daunting 326. 

And herein lies the conundrum of evidence-based medicine: There are nearly 700,000 medical papers published annually, according to William Miser, MD, MA, who wrote that a clinician reading 2 articles per day in 1 year would fall over 9 centuries behind in his/her reading (Prim Care 2006;33:839-62)! Furthermore, the quality of these studies is far from uniformly good. So how does a busy clinician sift through this gargantuan amount of information in order to provide up-to-date care to their patients? Well, the answer is that some, probably more than any of us care to admit, don't; I call the type of medicine they practice the "15-years-of-experience-based practice". This is an insidiously dangerous type of practice, since from an early age we are taught to trust the greying temples and the confident and condescending demeanor. 

Unfortunately, the only recourse for us as patients is to be educated consumers of healthcare. Now, I am not implying that everyone needs to start reading the 700,000 studies that come out annually. I am not even implying that all of us need to follow the "breaking news" stories about health and disease; in fact, I would steer clear of those, since the sound-bite format lends itself to sensationalist half-truths. My view is that every patients needs to be empowered and unafraid to ask certain simple questions of their healthcare provider. "Why" is the most important question to ask (as in "Why do [that is what makes] you think I have this condition?" "Why are you ordering this test?"), followed by "What are the chances" (as in "What are the chances that the test will tell us what we need to know?" "What are the chances that the information from the test is trustworthy?" "What are the chances that the test will give us the wrong information and send us down the wrong path?"), finishing with "What actions will we take?" (that is, "What actions will we take based on the results of the test?" "What are the possible consequences [both positive and negative] of these actions, and what are the chances of each happening?") If we start with a somewhat skeptical attitude and expect to have our questions answered respectfully and completely, we may be able to weed out the up-to-date from the outdated experience. But that doesn't really help me with my writer's block, does it?

1 comment:

  1. Ah, the dreaded writer's block. I know it well, have even opted for cleaning closets and vacuuming to avoid the keyboard. But you managed to banish it because you've beaten back the block and have produced a very interesting and readable article. What''s your secret?