This recent article from Brateanu A et al. in the „Cleveland Clinic Journal of Medicine“ tries to answer the question why we often act against better evidence by using the complete blood count before anesthesia as an example (we have all experienced that with pre-op outpatients: Healthy 18-years-olds who have to bring an absolute useless complete blood count with clotting times etc….). I would like to point out some interesting aspects of this article because they reflect and criticise our learning-expeience on a meta-level.
1.: We know that very well: It is much more difficult to get rid of some traditional action, process etc. (the authors of this article call it „to discontinue“ which is very accurate i think) than to implement something very new. This does not only apply for medical sciences but is very distinct in our field of activity (Keyword: „Emince-based medicine)
2.:Complexity and number of guidelines and recommendations are massively growing every year – yet our time does not. For example, the number of references in the ACC/ AHA-Executive Summary on the perioperative Guidelines has grown from 96 in the year 2002 to 252 in 2014. We can conclude from that: „Life-long Learning“ is not just a phrase for us – medicine is life-long learning, it is our responsibility to live according to it, it means permanent training. We do not only need our own intrinsic motivation for that but also ressources as far as time and money are concerned. FOAM can help and support us!
3.: Physicians don´t trust the evidence: we know that, too – for different reasons we act differently to how we should because we think we know it better or we pick out some particular aspects from papers and studies or we expect other results because oft he restricted and small number of our therapies etc. We often hear arguments that guidelines restrict our autonomy in medical action or confine our „Freedom“.
The authors show us some strategies to solve those problems on the end of this article – two of of them i think are very notable to me:
- „Local leaders“ should be found to help to persuade their colleagues and to bring the newest guidelines and findings tot he people. – bottom-up and not top-down!
- Clinical Practise Committees can analyse new guidelines for the particular hospital or unit and prepare and share them!
To sum it up, it’s a very interesting article, very notable, very exciting ideas! Absolutely worth reading it!
Reference: Brateanu A et al. Why do clinicians continue to order ‘routine preoperative tests’ despite the evidence? CCJM 2015 Oct;82(10):667-670.
Translated from Foamina!