Most medical practices are not parachutes

I was invited on EMCrit to discuss my position on idarucizumab and I fear I didn’t do a great job explaining myself. I don’t want to spend more time discussing the specifics of idarucizumab, but I think the larger problem of declaring that a therapy works without study, or declaring that it would be unethical to study a therapy because we “know it works” despite a lack of randomized control trials, is worth pursuing. Continue reading “Most medical practices are not parachutes”

Magical thinking in modern medicine: IV antibiotics for cellulitis

A summary of the evidence comparing IV to oral antibiotics for cellulitis

“I’ve been on these oral antibiotics for 36 hours and my cellulitis isn’t improving. My doctor sent me in because I NEED IV antibiotics.”

“This patient has pretty mild cellulitis, but he does have a fever, so I think we should go with IV antibiotics.”

“That is a pretty big cellulitis. There is no way it is going to improve with just oral antibiotics.”

Among physicians and patients alike, it is generally accepted that IV antibiotics are better than oral. They are stronger. They will work faster. They will save the day when oral antibiotics have failed. But do the bacteria floating around in the soft tissues of your leg really care (or even know) whether the antibiotics entered your system through a vein or via the stomach?

Continue reading “Magical thinking in modern medicine: IV antibiotics for cellulitis”

Articles of the month (March 2018)

A monthly (ish) summary of the emergency medicine literature

Every two months or so I write a monthly summary of the most interesting medical literature that I have encountered. This is one of those summaries. Continue reading “Articles of the month (March 2018)”

BNP in the emergency department: The evidence

A review of the BNP literature

In the most recent episode of Emergency Medicine Cases Journal Jam, Rory, Anton, and I cover the evidence for (for against) using BNP in the emergency department. These are my notes.  Continue reading “BNP in the emergency department: The evidence”

Articles of the Month (January 2018)

A monthly compilation of critical appraisals of the emergency medicine literature.

Welcome to another addition of the Articles of the Month. And yes, I know this is no longer a monthly publication, but it is always published in A month and you get what you pay for. The podcast version can be found over on Broome Docs. Enjoy. Continue reading “Articles of the Month (January 2018)”

Idarucizumab: Plenty of optimism, not enough science

A critique of the current science supporting idarucizumab

Optimism is essential. Few things are as powerful as hope for the future. When facing an onslaught of critically ill patients, optimism allows emergency physicians to persist. Optimism, however, can cloud also cloud our judgement; allow us to focus only on the good, not the bad. As physicians, we cannot afford optimism blindness. We need to be objective. We need to be scientists.

This month I was distressed to hear overly-optimistic, unscientific statements about idarucizumab on two of my favourite emergency medicine education programs: EM:RAP and EM Cases. I have incredible respect for these sources. EM:RAP has been irreplaceable in my emergency medicine education. On EM Cases, the statements were made by Dr. Walter Himmel, who is one of the smartest individuals I have ever had the opportunity to meet. But in this instance, I think that they were both wrong.

Continue reading “Idarucizumab: Plenty of optimism, not enough science”

Evidence Based Medicine is Easy

A simplified guide to approaching the medical literature

Evidence based medicine is easy.

I know that evidence based medicine scares people. That stats seem complicated. Papers are often full of obtuse language. People are constantly debating small details at journal clubs, which can leave many physicians feeling inadequate.

But I can assure you, evidence based medicine is easy. If I can do it, anyone can. The only difficult part is getting into the habit of actually picking up a paper and starting to read.

Continue reading “Evidence Based Medicine is Easy”