This happened yesterday. Our professor who has an experience of more than 25 years in surgical practice was doing a laparoscopic cholecystectomy. As I have mentioned so many times before he is a very friendly person and easily approachable for residents. Now my Junior who is in his second year of residency recently did a laparoscopic training course. There they taught him basic laparoscopy techniques and cholecystectomy on porcine specimens. Our professor dissected the Calot's triangle and clipped the cystic duct. Unlike we usually do he was in a little hurry and didn't mind to explain each step. Then my junior who was really enthusiastic after all that one week training questioned him, 'Are you sure?!!' (that you are clipping the cystic duct and not the common bile duct!!). Professor started laughing. Even I, who was holding the scope, could not prevent myself shaking the scope due to laughter.
Surgery and any other medical professions has got this peculiarity. Once we pass the degree, we are legally equal to our teachers. Now this is a reality, but it depends on individuals how he or she assimilates that fact. Even though senior resident has the same educational qualification as the professor, his clinical examination and treatment modality may not be the one the Professor wish. In this profession the thing that matters most is experience. Allthough it may considered class 3 or C evidence in context of evidence based medicine, it is the most important factor.
It is also another effect of this profession. You are at a position with ten years of experience and then a youngster who just passed out, come and question your decisions. Often you may not have an evidence based explanation for what you do, but based on a 'gut' feeling. Most of the time the youngster believes what he learned in books, but each patient is different and each one needs treatment or surgery, tailored to his or her need which an experienced practitioner can understand.
Surgery and any other medical professions has got this peculiarity. Once we pass the degree, we are legally equal to our teachers. Now this is a reality, but it depends on individuals how he or she assimilates that fact. Even though senior resident has the same educational qualification as the professor, his clinical examination and treatment modality may not be the one the Professor wish. In this profession the thing that matters most is experience. Allthough it may considered class 3 or C evidence in context of evidence based medicine, it is the most important factor.
It is also another effect of this profession. You are at a position with ten years of experience and then a youngster who just passed out, come and question your decisions. Often you may not have an evidence based explanation for what you do, but based on a 'gut' feeling. Most of the time the youngster believes what he learned in books, but each patient is different and each one needs treatment or surgery, tailored to his or her need which an experienced practitioner can understand.
People aren't crazy to have made levels of evidence. Not recognising the shortcoming of expert opinions is an egotistical outlook, relying on which, one is bound to repeat historical mistakes or remain content with whatever little one achieves.
ReplyDeleteI understand. People are not crazy to spend time and money creating guidelines and levels of evidence. But what I feel is, these are made for the majority of people who do not have the required level of expertise or knowledge of the historical evolution of the disease or the treatment modality of given variety. Guidelines are not fool proof. The same committee which recommends a thing, reviews it in five or ten years and say it is not recommended anymore. An experienced doctor who is passionate about his field of speciality and upto date about the literature will always know better. When such a person advices something out of his experience, it is worth following.
ReplyDeleteAnd sorry for my mistake, expert opinion without explicit critical appraisal will be a class 5 evidence according to Centre for evidence based medicine, Oxford 2009.
ReplyDeleteAgreed. Blindly following guidelines without tailoring them to individual patient is nonsense.
ReplyDelete