List Archives

Sat Jul 10 19:31:28 BST 2004

If there is any dark area in medical knowledge, that is the CNS,  normal
or under pathologic situation . Series, statistics, in most situations are
wide insufficient. The amount of information of the course of posterior
circulation, treatments and outcomes is far from conclusive.

But, I believe, there is other issue in Neuro patients that with your
uniform approach to medicine is dangerous (I am not talking about you as a
physician but as a voice that sculptures minds).

We,Human beings, are what our brain let us be. When we are dealing with
such type of patients we are handling the most important future of their
outcome. We deal with a patient, not with statistics or averages. There
are two types of Evidenced based  Medicine, the one provided by statistics
and the patient-bedside evidence based.

The popular evidence based medicine helps to see and organize health care,
investments, policies, resources, and to minimize the chances of
miss-diagnosis and mistreatment. This can result in good clinical results
related to the statistics but not for the single patient we are treating.
We can say that it is something we can tolerate. Now, neuro patients are a
different ball game: it is not the same to send a pt with 30% of  LVEF
when would have been possible to preserve it at 35%,  than sent a patient
with 5% less of the left temporal lobe when would have been possible to
preserve it.

Evidence based medicine as we know it does not discriminate the best
option for patient number 50 than the one for number 100. Are different
patients, with same disease but different individual factor affecting
their individual course, but by means of statistics they are forced to be
almost identical. Situation far from reality. Again this can be tolerated
in certain organs and systems, but no in all. The resulting difference in
neurological patients is talking or not, understanding or not, recognizing
or not, etc with a wide range of outcomes from very mild to severe, all
affecting deeply the life of the patient that we are responsible of.

I hope that whit out underestimating the Evidence Based Medicine we will
not abuse of it and try to use it where can be weak or harmful, as we
start to develop the concept of patient/tissue-needs bases medicine.

Remember, at least in medicine, we are always behind, always, at least, a
little bit wrong.

My goal is not to feel secure, but to secure the best outcome for the
single patient that is expecting the best outcome for his situation.

MY apologies, this is a difficult issue for my English
JM

> In a message dated 7/9/2004 9:19:14 PM Eastern Daylight Time, "Jorge
> Mirabelli" <pandanas at oregonfast.net> writes:
>
>>All medical decisions have benefits and risk. Doing or deciding no to do
>>are medical options and both under the same scientific requirements. Both
>>need the validation of the famous "evidence based medicine".
>>If in the present case your suggestion is not to do it has to based on
>>evidence.
>>In sciences everybody and every statement require the same rules. You are
>>not above this. So, master, teach. Do not be scare, if you do not have
>> the
>>evidence you require from others, let us know your personal experience
>>that I know it is very rich, and besides any present or absent evidence,
>>we will learn a big deal.
>>
>>Anyway there is no justification for the unrespectful messages in
>> response
>>to those who presented a case to the list looking for some good input.
>>Good medicine needs much more than a skillful hand.
>>
>>JM
> Sir--
> Obviously you did not read my last post, with the evidence in the
> literature for safety of nonop observation of vert artery injuries--now
> please tell me your take on this, and present me with evidence that
> refutes this to support the stance of intervening?
> ERF
>
>>> ....but gee, perhaps that's why i
>>>>brought it to this list in the first place.....hopefully others will
>>>> weigh
>>>>in on this case with more than just a cursory insult and dismissal....
>>>>jcw

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Case advice: Vertebral artery injury