Re: Observable behaviour

[Guest guest]

,

Clinical practice is not science. It is mostly art based on science. It

necessarily includes playing with probabilities and hunches. Relatively

few clinicians engage in research, and when they do, it tends to be a

very narrow aspect of their practice. They still play the odds, rather

than initiate a series of experiments for every patient. That is true,

no matter how many tests they order.

A scientific study is necessarily limited to a precise set of

conditions, even if it is double blinded and statistically controlled.

Depending on how those conditions interact, the very best conclusions

for any particular test are necessarily restricted to those conditions.

Sometimes no valid conclusion is possible from a particular test, but

sometimes no one realizes that until the conditions are refined in later

tests. That is one reason why dietetic recommendations keep changing.

The clinician plays the odds, based on the assumption that the

conditions leading to a particular conclusion, are common enough to

justify applying those conclusions outside the test conditions. In the

majority of cases, this works, which is why doctors continue to operate

this way. However, for the exceptions, the results can be tragic.

The problem is not with the double blind studies, with the science, it

is with the assumption that such studies apply universally; the problem,

when there is one, is with the clinical interpretation of the science.

As patients, we really need to recognize that there are cracks to fall

through, to educate ourselves fully about our conditions, and to engage

our doctors in dialogue, to make sure they recognize our conditions may

be exceptions to a rule. We should view our physicians as well informed

consultants, not omniscient beings. They are fallible, just as the rest

of us are.

Chuck