August 20, 2002

     What are we doing, and why are we doing it? Because that’s what we were taught. What we do is based on what we see, heard and practiced through and with our mentors. Are they always right? Of course, no one is infallible. There might be something new and better, right? Our practices might be obsolete, substandard, or not the standard of care. Are they aware of these because they read journals and attend conferences? Perhaps. But are they competent to perform it, and well versed enough to practice it? Blah blah blah. This is what evidence-based medicine is all about.

     The scientific method entails having a hypothesis, a methodology to prove or disprove it, then drawing a conclusion. This process can then be reviewed, repeated and proved by other investigators who are supposed to unravel the same results. This is the foundation of science; if anything is unproven at least theoretically, it is heresy and no better than superstition. That was how Koch’s postulates came about. For us in the medical field, it is no different. All that we do is based on previous research, or at least it should be. This is not static, but highly dynamic because new things get discovered, refuted, and improved all the time. That is why you and I no matter what field we belong to need to keep up with what’s going on. It’s like riding a bicycle: you gotta keep paddling lest you stop and fall. There is a need to be aware of new guidelines, new standards of care, new technology, new procedures and medicines. Doesn’t it irk you when a patient asks about something you never heard about, simply because he reads Time magazine or surfed the net? This doesn’t mean jumping into the bandwagon stat, prescribing the expensive new stuff or performing the latest procedure, but rather simply staying abreast.

     There are many ways. The easiest is by reading peer-reviewed, association supported medical journals. Yes, you are very busy, but you need continuing education. But choose what you read! Not all journals are equal. Many are over 50% ads and drug company biased because they are drug company paid. Some contain second–hand reviews and second-rate articles. However, some do contain published medical society guidelines and top-rated new important studies. These are the pearls. It takes practice and discernment to choose which ones to read and which ones to absorb. There is no need to list journal names here, but whichever your society supports is probably good. Try the New England Journal of Medicine for starters. We need better teaching in medical school on how to critically review a medical article, the practical side of research and how to publish it. More so in residency and fellowship.

     Then there is the internet, where you can virtually buy, read or search anything. This net is even harder to navigate, and you can get lost in many obscure, questionable sites. Try your own society’s website. Medline is always the best, because it is where you can find nearly anything and the latest. Other examples of good websites are: MD Consult, WebMD, UptoDate, and the CDC and WHO websites.

     Thirdly, get into as many conferences and meetings as you could. Not only the ones that a drug company sends you to, but to the meetings that really matter. Ones in which you can learn and contribute.

     Lastly, despite your busy schedule, try to get involved in research yourself. Your statistics background may suck, but let that not hinder you. If can’t do it yourself, sponsor it, or be an adviser or inspiration to somebody else. Publishing manuscripts benefits not only your resume and professional pride; it also benefits mankind.

     So don’t just keep doing what you have been doing all these years, and don’t just follow like rote what you are taught. Catch up, innovate and be the best that you can be.

     Enough said.

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     The author's e-mail address is at docdan1@pol.net.

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