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OB/GYN Editorial January 2003
Evidence is in the
Eye of the Beholder
Lee P. Shulman, MD
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Yes, we live and work in interesting times. Perhaps too interesting.
In the midst of our continuing travails with reimbursement, medical
malpractice, and a rapidly changing paradigm with regard to training
residents, those of us who care for mature women awoke on July
9, 2002, to the refrains of the Women’s Health Initiative
(WHI) on television, radio, newspapers, and magazines. In fact,
I now know what General Cornwallis felt like in Yorktown when he
played the tune “The World’s Turned Upside-Down” after
his unlikely and surprising defeat by the American colonials. The
world of menopausal management had truly been turned upside down—and
right side out.
My intent in this column is not to debate the various points of
the WHI—there are far more eloquent and knowledgeable voices
on all sides of the various issues making their opinions known
and adding to our understanding of this trial and its impact on
clinical care. What I would like to address is the evidence, or
rather, the presentation of the evidence. Television newsbroadcasters
Peter Jennings and Wolf Blitzer are probably not the best people
to present complicated and controversial medical information, especially
within a limited medium such as the evening news. Daniel Schorr
of National Public Radio summed up this concept in an eloquent
manner. When speaking of the press coverage of the anniversary
of the September 11 terrorist attacks, he stated that the press
was very effective in communicating emotion, but rather ineffective
in communicating information.
That our patients are making decisions based on partial information
and poorly understood concepts of relative and absolute risk is
an example of irresponsibility and the lack of understanding by
the members of the lay press for the complexity of scientific and
medical studies; this has been, and continues to be, the source
of considerable problems for our patients and makes our practice
of medicine even more challenging. However, the controversy surrounding
the WHI does not alter our most important responsibility: be the
patient’s advocate and provide her with understandable and
even-handed information in a caring environment. Regardless of
the decisions made by our patients concerning a variety of clinical
issues, every woman relies on her physician for accurate information
and empathetic care. If we fail to be the source of reliable information
for our patients, then we will cede that critical aspect of care
to the press—and they have shown to not have the same interests
in our patients as we do.
We must stay informed and well-read if we are to maintain our
central role in the care of our patients; this will make us better
clinicians
and more valued professionals for our patients and our communities.
Our patients expect and deserve no less.
Lee P. Shulman, MD
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