undergroundOps

I also wouldn't call most of us scientists, though many at university hospitals are.

I think the problem is that it's simpler to just take a study's conclusion and believe it. Because hey, it's peer-reviewed and in the NEJM! Easy!

The adverse reaction I described is normal in medicine when you oppose the status quo. That's probably true in other professions and industries.

I was simply suggesting what we all learn in medical school and residency: to appropriately evaluate clinical studies. Just don't think most doctors do.

Let me give you an example of how I approach things. The guidelines for acute pancreatitis recommend using a fluid called LR instead of NS for volume resuscitation. This is based on an single study that included 10 patients and simply noted slightly better lab numbers; there was no difference in clinical outcome. Lots of problems with that study, right (small, underpowered, confounders, validity issues, etc)? However, there's no major disadvantage for using LR in those patients (unless hyperkalemia is a concern), so I use it since it might have a benefit.

This is a very simple example. It gets much more complicated than that.

"Probably" is one of favorite words in medicine, btw :).

I'm a physician and I've been suggesting this to my colleagues for a few years, only to be met with alienated stares and labeled cynical.

The doctors and doctors-in-training I work with have altruistic motives, but place too much stock in major medical studies. They also frequently apply single-study findings to patient care, even to patients that would've been excluded from that study (saw this a lot with the recent SPRINT blood pressure trial).

And don't even get me started on the pulmonary embolism treatment studies. What a clinical mess that is.

It's frustrating.