Daniel Crook, @EMSafe dropped this in twitter a couple of weeks back:
I realise that I have had to learn and do medicine in 7 different ways:
What the book says
What we actually do
What the course says
What the College/exam wants
What the boss wants
What the evidence says
What other people will do who don’t know the evidence
I’ll add this one:
What to do when the clinical picture isn’t clear.
Physicians often work in situations that are poorly defined. Even with our best efforts at defining a situation, the key elements aren’t always there like in the studies.
Despite the world portrayed in text books and consensus opinions, many of us operate in a zone of medical uncertainty. We do the best we can with the evidence we’ve got and the patient before us.
I heard recently that the difference between a palm reader and a physician is evidence. I can’t disagree. Of course, evidence can only impact care when it fits the studied circumstances.
Sometimes we still have to ask to see the patient’s hands.