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I recently listened to a podcast about avoidable incidents,1 including one where a ship was steered onto a reef by an extremely experienced captain. He’d headed off down the quicker route and, despite all the evidence of the situation worsening, kept on going.
For me, it struck a chord, as how we sometimes act in medicine. We will come up with a diagnosis, and can sometimes stick to it even when other pointers are heading away from it. We will keep on going with one therapeutic manoeuvre, sometimes increasing in its intensity, despite things deteriorating. It’s sometimes the locum doctor, or the new pair of eyes after a holiday, or the influx of new trainees that allows us to see what we’re stuck in.
This catches us in doing evidence-based practice too. We can be asking only questions we really know the answer to, for example, and only open those questions when we hear or see something that intrigues us. And we often appraise the ‘wrong’ answer harder than the right one. To get around this aspect of being ‘stuck’ in current practice, try to mirror the appraisal points fairly. If you’re asking only for blinded trials of the new treatment, also wonder where the blinded clinical trials are for the old one. If you’re concerned we don’t have solid long-term cohort or dosing data, spin the same lens onto what you’re doing right now. There is definitely something to be said for experience and learning from doing, but don’t let the momentum of your current way of doing things make changing course impossible.
Provenance and peer review Commissioned; internally peer reviewed.
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