Month: June 2016

Enterprise Gone Overboard

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My satellite clinic is about an hour away. I drive there with my nursing staff each month.

We load up ECG equipment, pacemaker programming machines, and a few other doctoring items in my truck.

I provide services to an area that has no permanent resident doing what I do.

Then, I return home.

Today is one of those days. I arrive back to my main office. It’s after 5pm and officially closed for the evening. I hurry to help my remaining staff return numerous phone calls to patients who had left messages while I was away. I hope to finish up at the office soon. Then, I intend to check on a patient at the hospital before making it home for dinner with my family.

I peer down at a piece of paper on my desk, given to me by one of my staff. It’s a printed email message. Sent by the Centers for Medicare and Medicaid Services (CMS).

The message is arguably from the most descriptive email address on the planet—and I’m not making this up—it’s from DONOTREPLY@CMS.GOV.

DONOTREPLY.

It’s rather fitting.

Because they definitely don’t want you to reply. That would be easy for me. Too efficient, perhaps. No, they don’t want a reply. They just want me to DO what they say.

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The Bullfight For Evidence

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It’s been a chatterbox kind-of-week for evidence-based medicine.

First, an article appeared in the New England Journal discussing its limitations. Then, a rebuttal came from an established bull in the China shop, and we were well on our way. Ultimately, all sides made a point.

Seemingly bored by the chatter, however, may have been Medical Progress herself. She has and will continue to move forward on her own terms—sometimes with and sometimes without randomized controlled trials.

There are not many novel ideas to discuss here. Evidence frequently has claimed to be guiding medicine. Sometimes it has originated from the experience of a single person or two. Sometimes pseudo-clarity has required the trials of ten-thousand. Only very recently has evidence even existed for some in hierarchical structure—”hard” or “soft” these people now say.

But, what does “hard” or “soft” evidence really mean anyway? And, who gets to define these terms?

The policy makers?

The New England Journal?

The bull? The baker? The candlestick maker?

Almost contrary to what the gnostics of evidence proclaim to be best, the majority of individual medical decisions are made using so-called “soft” evidence. And, no, this isn’t some atrocity.

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