"The 15 minute slot/patient is another question entirely. That's what happens when the "bean counters" and MBA's run medicine. It doesn't allow enough time for even a good physician to catch everything, and mistakes of omission and commission do get made."
This is the main 'problem' with GPs, and I'm not saying it's their fault, just that that's the way it is. Same could be said of many reader reviews (I'm guilty of this too). Because I'm not paid to write gear reviews, I don't put a lot of time and comparative study into my reviews. I have more pressing things to do with my time.
"to say they are all in the hip pocket of the pharmaceutical industry or rely on "anecdotal" information is, IMO, way over the top. I've known far too many talented, conscientious physicians to buy into that."
I've taught too many med students (more to the point I've seen the teaching curriculum that many of my teaching colleaugues put forth as curriculum) to believe otherwise. Again, it's not the student's fault. Most of them are VERY talented and motivated. It's just that a lot of traditional western medical teaching is based on empirical data rather than evidence based. And a lot of the pharmaceutical "evidence based" info is so totally skewed and mis-represented that the poor students don't have a hope of sorting out truth from mis-truth. It's not the doctors that are bad, just the system they are raised in. I think with the information age that this is changing rapidly, and the new crop of med students will hopefully come out more well rounded and with a decent back ground in assessing the merits of information put in front of them as the *gospel* for what it really is. It is only very recently that Evidence Based medicine (EBM) has been formally adopted into most med schools.
Here's an example of what I mean:
To ascertain general practitioners (GPs) views about evidence-based medicine (EBM), perceived barriers and preferred resources to support evidence-based general practice; to assess GPs familiarity with technical terms commonly used in EBM. METHODS: We developed a self-administered questionnaire from an existing instrument. A random sample of GPs completed the questionnaire at the commencement of a trial to improve preventive care. RESULTS: Sixty GPs (100%) participating in our trial returned the questionnaire. The most commonly cited barrier to EBM in general practice was patient demand for treatment despite lack of evidence for effectiveness (45%), followed by lack of time to read and appraise research articles (40%), lack of time to search for evidence (28%) and lack of time to discuss the implications of research findings with patients during routine consultations (25%). Fewer respondents cited insufficient skills in appraising evidence (16%), searching for evidence (12%) or communicating the implications of research to patients (5%). Preferred resources for EBM included clinical practice guidelines (rated as very useful= by 55%) and journals that summarise research evidence, for example Evidence-based Medicine (52%). Systematic reviews were considered very useful by only 15% of respondents however. Unexpectedly, 30% of respondents indicated that they did not understand the term “systematic review” and 43% did not understand “meta-analysis”. Only about one quarter of respondents indicated they fully understood the terms “relative risk” (23%) and “absolute risk” (28%) and could explain these terms to others. In comparison, only 15% of respondents indicated they had the same level of understanding of “number needed to treat”. Even fewer respondents (12%) indicated they fully understood the term “levels of evidence”. CONCLUSIONS: Barriers to EBM in general practice were perceived to be related to time rather than skills. However, GPs lack of familiarity with technical terms commonly used in EBM suggests lack of training. Skills development will be important to strengthen an evidence-based approach in general practice. If methodological research supports the validity of self-assessment of understanding of EBM terms, this measure could be used to evaluate the impact of educational strategies.
A lot of BPL articles lean towards an evidence based approach, especially when compared to other sites and reader reviews. To me, that alone is worth the price of admission.
Oh, and a big hug to all those GPs that do incorporate a good dose of evidenced based medicine into their practice. I know they're out there, they're just not yet the mainstream (and may never become mainstream if HMOs take over the world). It does take extra time and effort, and they should be rewarded (financially) for aquiring and disseminating that knowledge to their patients, just as BPL deserves to be rewarded financially for paying experts in their fields for doing high quality research and publishing it. However, there are always folks like evan who just don't value that info enough to want to contribute to it. And that's what a free-market is all about. Non-members are pretty lucky on this forum. Many exclusive forums don't even allow non-members to read forum posts, much less contribute.