🤔 The Dilemma of Evidence 💡

Therapy A for Medical Condition X was generally recommended by the evidence-based guidelines issued by several professional societies. It was the standard treatment for X for many years. 💊

Five years ago, the guidelines were changed (as often happens) to remove Therapy A from treatment recommendations of Condition X. ✂️

And then, recently, the guidelines were changed again to include once again, Therapy X in the recommendations. (This also happens commonly.) 📝

Now here’s the dilemma.. ⚖️

Dr P continued to prescribe X to his patients during the last 5 years. While Dr S followed the guidelines and stopped prescribing X in the last 5 years, and started again when the latest guidelines came out! ⏭️

Who do you believe did the right thing, Dr P or Dr S? ☯️

My thoughts are below, but do think of an answer before continuing to read further.. 👇🏾

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My answer is.. it depends.. 🤷🏽‍♂️

Both Dr P and Dr S could be wrong. Dr P is wrong if he/she blindly ignored the guidelines, and Dr S is wrong if he/she blindly followed the guidelines. 🙈

We need to be aware of the current evidence in our field. Evidence-based guidelines are released by professional societies for many common clinical questions, after reviewing the research studies that have been done on the topic. They can help as short-cuts to absorb the “cutting-edge” changes in our respective fields. Without them, we may continue prescribing outdated therapies, while newer therapies with more effectiveness and less adverse effects may be available! 📼

At the same time, we need to be aware of the pitfalls of these guidelines, and not follow them blindly. Many guidelines are not evidence-based at all! They’re just based on the “experience” of the “eminent experts”, and are often biased and uninformed. Good evidence-based guidelines state very clearly which research studies they’re basing their recommendations on, and the “strength” of those recommendations. This strength is determined on the basis of the number and quality of research studies supporting or refuting that particular recommendation. Some recommendations may be based on “weak evidence”, and those are the ones we need to be especially careful with! 📊

Also, some recommendations are based on research done on only one race, gender, or socioeconomic context. So, we need to apply our own judgement whether the recommendations are suitable for our particular patient and their context. 🏘️

So, both Dr P and Dr S could be right, if they’re taking the effort to read the guidelines, to understand which recommendations are based on what strength of evidence, and to make the judgement whether the guidelines apply to the context of the patient in front of them! 🧠

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