It's not bad actually, considering how many times the new shiny thing has turned out to be quite dangerous a few years later.
In a field as high stake as healthcare you want the whole spectrum, from early adopters to die hard skeptics.
Especially since we know the reproducibility problem of research, the influence of big pharma and big insurance on healthcare, etc etc
People shouldn't worry about accuracy too much. Everybody in healthcare knows about the problems in various measurement methods as well as individual responses to measurement anxiety and the physical and emotional state you are in that particular time. The only accurate measurements are direct measurements through an arterial catheter which is a very invasive procedure.
Routine clinic measurements are used only to have a general idea about trend and secondly to catch severely high BP which is usually due to a secondary disease.
Also, if BP is high above a certain limit it is significant regardless of if you took rest for 5 minutes and other precautions. Because if BP is high the normal BP regulating system should kick in and lower it regardless of the cause. With advancing age and hardened arteries this response becomes less optimal and you need the support of anti hypertensive medicines. You can see this in real time in patients under anesthesia. A young healthy patient would have an initial peak in response to pain or other surgical stimulus but they will be able to lower it either spontaneously or with minimal outside intervention. Whereas in older individuals much more effort is required to control and lower the BP.
The general trend has been to treat both hypertension and diabetes early because the microvascular complications start much earlier before they become apparent clinically.
No, “everybody” in healthcare does not know this. I have learned to be skeptical and not to assume any particular level of statistical competence in the healthcare field.
Nurses/healthcare professionals often take the patient's blood pressure and heart rate just as soon as they enter the room after walking and moving about. Wait a few minutes and the measurement changes significantly, giving you a better indication of actual heart rate at rest.
I went in for a checkup and my doctor actually retested me after a few minutes because the first reading was unnaturally high. Hurrying into the office and the general anxiety of being in a hospital certainly raises it by a bit.
I get the sentiment, but let me add one thing. Understanding statistics well is far from "common sense". In general, to operationalize statistics well, one has to both (a) train your mind quite carefully beforehand, and (2) slow down in the moment to make sure your rational thinking modes have traction.
Agree 100 percent. Perhaps the present generation doesn't know about the early days of Wordpress. Also, all this wording may be because Matt is very committed and so emotional about the protection of open source projects
Excellent article. Practicing anesthesiologist of 25 years. Agree 100 percent with the problems highlighted in the article. These problems are increasing day by day with increasing algorithmization and protocolization of everything. So as the article mentions , there are two many individual variations and edge cases in day to day practice of medicine. An experienced doctor will have a a pretty good idea if following a protocol blindly can harm a patient but if they act on their experience and deviate from protocol they are open to liability even if the outcome was good. But I don't believe humanities education us the answer to this problem. It needs a system wide reset.
What's wrong with the simple solution, i.e., understanding when the algorithms apply and when they don't? For example, if an RCT shows that in-hospital initiation of all 4 of the heart failure GDMT's leads to reduced mortality compared to delayed initiation of GDMT, then you also have to learn that 97% of patients in the study had a baseline SBP of at least 97. Therefore, maybe you shouldn't start 4 BP-lowering meds on your HF patient with a baseline SBP of 86. If people learn when to apply rules, then I think you don't need humanities education and you don't need a system-wide reset either.
The issue isn’t the doctor knowing when to use the algorithm and when to deviate, but explaining that deviating from the algorithm was the right choice to the judge and jury in the subsequent lawsuit.
I think people have difficulty in comprehending the risks just from having been presented data and not seeing or talking to somebody having complications. For example I work in healthcare and have never seen an Opthalmology consultant to chose these procedures for themselves or their family.
