Knowledge in Medicine – Defining the Problem
In this age, we aspire to practice evidence-based medicine , which has been described as an approach that applies “the best available evidence gained from the scientific method to medical decision making.” (Sackett DL, Rosenberg WM, Gray JA et al) Instead, we are more likely to practice memory-based medicine meaning that “Current medical practice relies heavily on the unaided mind to recall a great amount of detailed knowledge.”(Crane RM) Our failure to practice evidence based medicine is endemic throughout medical care, as documented by McGlynn et. al. who found that barely 55% of patients get recommended care, and that this could be seen in the management of multiple conditions (Figures 1 & 2). Furthermore, the average time from the discovery of medicine to reach patients is 17 years – because of the slow adoption of practice changes.(Balas EA, Boren SA) ….
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Elissa M. Ozanne & Adrienne O’Connell & Colleen Bouzan & Phil Bosinoff & Taryn Rourke & Dana Dowd & Brian Drohan & Fred Millham & Pat Griffin & Elkan F. Halpern & Alan Semine & Kevin S. Hughes
Abstract: Family history of cancer is critical for identifying and managing patients at risk for cancer. However, the quality of family history data is dependent on the accuracy of patient self reporting. Therefore, the validity of family history reporting is crucial to the quality of clinical care. A retrospective review of family history data collected at a community hospital between 2005 and 2009 was performed in 43,257 women presenting for screening mammography. Reported numbers of breast, colon, prostate, lung, and ovarian cancer were compared in maternal relatives vs. paternal relatives and in first vs. second degree relatives. Significant reporting differences were found between maternal and paternal family history of cancer, in addition to degree of relative. The number of paternal family histories of cancer was significantly lower than that of maternal family histories of cancer. Similarly, the percentage of grandparents’ family histories of cancer was significantly lower than the percentage of parents’ family histories of cancer. This trend was found in all cancers except prostate cancer. Self-reported family history in the community setting is often influenced by both bloodline of the cancer history and the degree of relative affected. This is evident by the underreporting of paternal family histories of cancer, and also, though to a lesser extent, by degree. These discrepancies in reporting family history of cancer imply we need to take more care in collecting accurate family histories and also in the clinical management of individuals in relation to hereditary risk.
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