Titin.net

You probable came across Dr. Jill Bolte Taylo’sr story. She is the neuroscientist that had left sided hemorrhagic stroke. She describes her sensations and feelings from within the stoke. She describes her experience in details in her book: ‘My Stroke of Insight: A Brain Scientist’s Personal Journey.’

The point I would like to pose: should family physicians and clinicians in general read books the describe in details patients experiences. Medical books are written by the experts. This would describe their respective of what is happen. This is not totally bad, as in many cases leads to reaching a diagnosis and curing serious diseases. But, with the dominance of chronic disease as diabetes, should we as clinicians immerse ourselves in our patients experiences.

The neuroscientist Dr. Jill Bolte Taylor did not choose to have the stroke. But, here experience shed like to a side of medicine that we should focus on if we wanted to deliver quality healthcare.

 Dr. Taylor’s website

second in Saudi Arabia is death secondary to a myocardial infarction (MI). MIs are caused by atherosclerosis. Stress (treadmill) test and myoview shows partial obstruction of the coronary arteries. Unfortunately when obstruction is less then 50% these tests do not usually detect this problem. Plaques causing 50% obstruction cause most of half of MIs!
So, the best method to prevent sudden death is not to relay on imperfect tests that give false reassurance and live a healthy life: good diet, exercise, stop smoking and control diabetes and hypertension.

I will leave you with this quote from an article by Rackley, C. & Weissman, N. published in uptodate.com:
In comparison, acute coronary and cerebrovascular syndromes (unstable angina, myocardial infarction, sudden death, and stroke) are often due to rupture of plaques with less than 50 percent Support for this conclusion comes from studies of patients with an acute coronary syndrome who had had a recent prior coronary angiogram; the artery involved in the subsequent acute coronary syndrome was usually only moderately diseased.

Donald M. Berwick, MD, MPP, President and CEO, Institute for Healthcare Improvement On Demand: Eating Soup with a Fork
Today I watched/listened to an outstanding presentation by Donald M. Berwick, MD, MPP, President and CEO, Institute for Healthcare Improvement titled: Eating Soup with a Fork.

He answers one of my skepticism about the usefulness of evidence based medicine (EBM). He points out that using Randomized Control Trials to find the usefulness of complex processes is misleading. For example the RCT done to find the usefulness of cardiac events rapid response teams that these teams make no difference in outcome. These are multidisplinary teams that are mobilized once a cardiac event (mainly a myocardial infarction) is realized. RCTs are good for finding the usefulness of a drug or a surgical procedure. RCTs are misleading if used incorrectly to find the usefulness of complex process as rapid response team, anticoagulation clinic and complex stroke rehab programs. He points out that to perform RCT we blind ourselves of what is happening and just focus on one point or problem. In complex systems we need to know the details of what is happening to seen what things when available we get the desired outcome. This is common in business. The authors of the business book Good to Great when on looking to see what made good companies good.He points out that we need new ways to learn. We need to way to produce new knowledge. I am left with one criticism against EBM need for RCTs. RCTs take too, too, long and will never answer all our questions. So, Should we just stop thinking till we have RCTs?I totally agree that we should never go to the pre EBM era. But we truly need new ways to discover new knowledge in medicine. Methods that would give us the confidence that RCTs give.