n=1 or n=megabytes?

I had thought there were two types of SHOs (residents): those who analysed clinical problems, considered solutions, then requested approval; and those who placed their intellect carefully in neutral and asked what to do. Post Sackett,¹ a third type is emerging—the cyber-SHO, armed with fingers as sensitive to a palmtop keyboard as to a 25 g Venflon.

We invited one such to let us into his professional secrets (page 373). The trouble is I'm not sure I agree with the evidence-based solution to his clinical vignette.

 1 Sackett DL, Strauss SE, Richardson WS, et al. Guidelines. In: Evidence-based medicine: how to practise and teach EBM. Edinburgh: Churchill Livingstone, 1996.

n = blind prejudice

In contrast, we also look at habit-based medicine. Leeds (UK) is fortunate in having a department of clinical effectiveness. (Does anyone have a department of clinical ineffectiveness?) Farshi and colleagues (page 393) surveyed local hospital paediatricians and surgeons on their attitudes to circumcision. Unsurprisingly, surgeons tended towards cutting and physicians to preserving. Individual opinions varied greatly; alarmingly, 15% of surgeons approved of operating on …