Neil Chanchlani is a CMAJ Associate Editor and clinical research fellow at the University of Exeter, UK. He recently attended the 8thEBMLive conference in Oxford, England.
All healthcare practitioners are encouraged to make decisions that are based on strong evidence. But often we don’t – sometimes because the evidence is poor and conflicting, other times because we are ignorant and unaware and, rarely, because we aren’t comfortable with updating our practice. So we need to keep Evidence-Based Medicine (EBM) on the frontline and not on the (academic) shelves - we need to remind clinicians, researchers, and patients that decisions should be based on the best possible data. ...continue reading →
Cory Peel is a GP-Anesthesiologist who locums throughout British Columbia, Alberta and the Yukon
A couple of months ago I read Mike Hager’s article in the Globe and Mail about Dr. Reggler’s tribulations at St. Joseph’s Hospital in Comox, BC, and I was overcome by a realization that, despite having been a practicing Family Physician for 7 years, I had culpably little understanding of the prejudicial impact of faith-based hospitals in determining patient access to care.
The article detailed the refusal of the “Catholic hospital” in Comox to provide medical aid in dying to its patients despite having a staff physician willing and able to do so, thereby forcing them to be transferred elsewhere. That such a policy could exist stunned me. It is the work of “the bishop [a.k.a. the Diocese of Victoria] and the hospital board,” with the board’s CEO maintaining that “minimizing patient discomfort and pain is always the highest priority,” which seems to me to fly in the face of logic.
It is not, however, an isolated example. Canada contains many hospitals whose delivery of healthcare to its patients is directed by Church doctrine. ...continue reading →
Kira Payne MD, FRCPC, is a recently retired psychiatrist and jazz musician living in Toronto, Ontario
You would think it would be easy to be an expert in the information age: all those books and journal articles, indexed in libraries, ready and waiting to be perused; all those digital bits and bytes coursing through the internet, searchable on academic databases or Google; all those archived videos on You Tube providing information on everything from how to calculate Pi to how to fold a t-shirt in only 2 seconds. Wikis abound, democratizing information, enabling it to exist in a continuously amendable form. Information is everywhere and growing exponentially. It is “kid in a candy store” stuff, right? But there is something sinister about the overabundance of information. Reminiscent of a Grimm fairy tale, there is the very real possibility of paradoxical starvation despite the bounty. ...continue reading →
Recently, members of the health care community and the public at large mourned the loss of neurologist Dr. Oliver Sacks. My grandfather, also a neurologist, sent me one of Dr. Sacks’s books when I first expressed an interest in applying to medical school. I have since enjoyed many of his other written works.
Earlier this summer, the health care community also lost another tremendous leader, Dr. David Sackett, the father of evidence-based medicine. On my first day of medical school, I remember receiving one of his books too, and to this day it remains a fixture on my bookshelf as a resource.
It may seem odd to bring these two doctors together, because they held such divergent views of the clinical world. ...continue reading →
The practice of evidence based diagnosis is what we are taught we should all do, but, in practice, this is quite difficult. EBM diagnosis relies on likelihood ratios, but it’s impossible to remember the diagnostic accuracies of the thousands of tests that exist.
This is why I made a simple tool to help with the scientific diagnosis of diseases spanning most specialties. It is a database of over 700 likelihood ratios of tests (history, radiology, physical exam etc.). The likelihood ratios are completely free for all to access ...continue reading →
Chris van Weel is Emeritus Professorof Family Medicine at Radboud University, the Netherlands, and Professorof Primary Health Care Research at Australian National University, Canberra, Australia
Primary care in the Netherlands
What do populations need?
The aging population, the increasing number of people with chronic disease and (co)morbidity, the frail elderly, and the increasing number of migrants from Eastern Europe, the Middle East and Asia present a challenge for the health care system. The government increasingly promotes preventive and self-responsibility strategies for people to better manage their own health. ...continue reading →