These are a couple interesting commentaries regarding the state of clinical evidence and the difficulty of applying it at the point of care. One, from the BMJ, worries about the sheer number of studies and trials being generated, and that the data will never be able to be appropriately digested, and we’ll all die slow deaths from information overload. And, to some extent, this is true – how many of us carry around “peripheral brains” in our pocket? Before smartphones, it was the Washington Manual or Tarrascon’s, and now we have MedCalc, Epocrates, etc. And, we desperately try to simplify things so we can wrap our brains around it and integrate it into a daily practice by distilling tens of thousands of heterogenous patients into a single clinical decision instrument like NEXUS, CCT, CHADS2, etc. While this is better than flailing about in the dark, it’s still repairing a watch with a hammer. These tools tell us about the average patient in that particular study, and have only limited external validity towards the patient actually sitting in front of us.
Dr. Smith’s BMJ article proposes the “machine”, which is a magical box that knows all and provides seamless patient-specific evidence. Dr. Davidoff isn’t sure that’s feasible, and, as a stopgap measure, promotes the rise of the informatician or medical librarian, a new role for utilizing the available electronic health databases. This librarian will be expert in reading medical literature, will be expert in data mining healthcare information systems, and discover the most relevant ways to target quality and guideline improvement initiatives.
They’re both right, in a way. And we should definitely train and mature the growing discipline of this clinical informatician while we keep working on the magic box….
http://www.ncbi.nlm.nih.gov/pubmed/21558524
http://www.ncbi.nlm.nih.gov/pubmed/21159764