| Subject: objectivity |
Author:
krz
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Date Posted: 10/22/04 2:25:50pm
In reply to:
pa
's message, "reintegrating the 'word'" on 10/22/04 11:48:55am
I teach a class 'Tools for Evidence Based Practice' which is sort of a hybrid between a stats class, a research methods course, and a course in critical reading.
The premise is that in the medical community we have 'evidence' coming from many sources. What we need is a rubric to 'grade' the evidence for quality/strength (so there's strong evidence, moderate evidence, and weak evidence). This way, when exploring the vast, sometimes contradictory findings in practice we can at the end say ' the preponderance of evidence points us in this direction' and I am (confident, moderately confident, not confident but it's the best there is) in my treatment decision as a result.
Good evidence: randomized controlled trials - not many of them out there
Moderate evidence: cohort studies (sort of the baseline - after treatment comparisons)
Weak evidence: case studies or case reports, single subject designs, expert opinion (e.g., text books or the latest gurus talking)
Long/short - If I have a randomized controlled trial that negates the comment of a guru - I practice based on the randomized controlled trial finding.
This is what I was hoping for when I asked pjk for a sniff test for his evidence (have we lost you pjk? i sincerely hope not)
When dealing with the decidedly more messy 'real' world - I still retain some of this thinking. Personally, opinion ranks down there as weak evidence regardless of the reputation of the individual. I place bipartisan reports (like the 9-11 commission report) as moderate evidence - sort of the pre/post analysis as it were. I consider strong evidence to be that like economic indicators, inflation rates, gas prices, jobless rates, graduation rates, numbers of vials of influenza vaccine available, $ in political campaign contributions, etc.... How these data triangulate into policy is weak evidence however (becuase it's usually formed by expert opinion), but sure is great fodder for discussion.
A final treatment decision (again, back to my students) is made by incorporating what we know about the evidence with the values of the patient.
As a conclusion, as I always tell my students, making a decision with weak evidence is better than making a decision with no evidence at all. We all have to learn to make decisions in uncertainty, and the discourse with others will help us find comfort in those uncertain times.
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