A rant about guidelines (and an opportunity to help shape the future of the ILCOR guideline process)
I hate guidelines. I shouldn’t. In theory, summaries of the medical literature that are accessible to practicing clinicians could only be good. Unfortunately, in current practice, medical guidelines are too often biased, unscientific, overreaching, or misleading.
Continue reading “I hate guidelines (but they can improve and you can help)”
A response to and discussion of a critique of evidence based medicine (EBM)
A recent podcast has caused a bit of a stir among the nerdiest of my friends. This post, in large part, is a response to that podcast, but more than that, it is a discussion of the role of science and evidence in modern medicine, so you might find it interesting even if you haven’t heard to podcast I am talking about.
Continue reading “Evidence based medicine is still the best kind of medicine”
Does saying “quiet” really cause chaos?
I did it again. I was at the nursing station in our resuscitation area and I commented on how quiet the night had been so far. Of course, all hell broke loose. Continue reading “I said “quiet””
What follows is a post that you will see on a number of websites this week explaining the petition to retract the 2018 Surviving Sepsis Campaign guidelines. You can read the guideline here. Although many of the individual recommendations seems reasonable, I think these guidelines could end up harming patients. Continue reading “Petition to retire the surviving sepsis campaign guidelines”
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”
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”
Does sucrose really relieve pain in infants?
It is time for a (potentially unpopular) rant. Over the last few months, the topic of using sucrose for pain control in neonates has come up a number of times. It has been called the standard of care. It has been stated that it is unethical to run any more trials with a non-treatment arm, because we know that sucrose works.
I have a problem with that.
Continue reading “Sucrose: Analgesic or placebo?”