The British Medical Journal's great blogger Richard Lehman has published the following Ten Commandments for excellent clinical practice. These are great rules of thumb for any savvy health care practitioner--but they do require that wee bit of extra work to truly understand the statistics behind the medical literature.
(Hat tip to Steve Balt, MD, for sending me the link).
The New Therapeutics: Ten Commandments
- Thou shalt treat according to level of risk rather than level of risk factor.
- Thou shalt exercise caution when adding drugs to existing polypharmacy.
- Thou shalt consider benefits of drugs as proven only by hard endpoint studies.
- Thou shalt not bow down to surrogate endpoints, for these are but graven images.
- Thou shalt not worship Treatment Targets, for these are but the creations of Committees.
- Thou shalt apply a pinch of salt to Relative Risk Reductions, regardless of P values, for the population of their provenance may bear little relationship to thy daily clientele.
- Thou shalt honour the Numbers Needed to Treat, for therein rest the clues to patient-relevant information and to treatment costs.
- Thou shalt not see detailmen, nor covet an Educational Symposium in a luxury setting.
- Thou shalt share decisions on treatment options with the patient in the light of estimates of the individual’s likely risks and benefits.
- Honour the elderly patient, for although this is where the greatest levels of risk reside, so do the greatest hazards of many treatments.
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6 comments:
Very cool! Some common sense for a change. Our professions of medicine and psychiatry seem to be increasingly lacking in this regard.
This really helps refocus our ideals as physicians.
This is the credo of evidence based medicine. The problem with EBM is that the evidence is not evidence, it is simply statistical probability in clinical trials. Of course, "statistical-probability-in-clinical-trials based medicine" does not sound as spiffy as evidence based medicine, and besides, do you want to argue with EVIDENCE? What are you? A denier?
If the NNT is 100 and n=1 patient is sitting in front of you, how will you decide whether or not to treat?
Excellent post. Like what Frank said, these "commandments" are totally requiring one's common sense, yet most of us often forget to apply it.
#11: Thou shalt remember that one third of adults have low levels of health literacy, and that all patients deserve clear and concise information at their level of understanding.
Good that i learned this commandments this early in my education. I hope i will be able to apply them in all my practices.
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