General

What should we do when we are facing absence of evidence?

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4 Aug 2016 - General
 

 

Nowadays, evidence based medicine is the main principle of practising clinical medicine. The level of evidence will range from Level  1a, 1b, 1c, 2a, 2b, 2c, 3a, 3b, 4 and 5. The best evidence available will be the Level 1a evidence, which is a systemetic review and meta-analysis of multiple randomised control trials for a specific area or treatment or management. The lowest level of evidence is level 5 ,which is an expert opinion.  Usually, the appropriate medical authority/body will summarize the the best available evidence, and put all togther into a guideline for some certain specific disease.  But, sometime, we do face some clinical uncertainty or question, that did not have much reliable evidence out there to support our decision making, what would you do in those situation ??

Yes, you are definitely right, "The absence of evidence, is not the evidence of absence." Actually, there are a lot of medicine we that we are still using were not developed or evolved through the current ladder of evidence based medicine. The very obvious example will be the penicillin. During that period of time, the medical used of penicillin was not proven through a systematic review or a randomised controlled trial. Not everything in our daily clinical job is based on evidence bas...
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For this topic, I will quote one of my mentors. "The absence of evidence, is not the evidence of absence." (Dr. Artemio Roxas) Say for example, a negative Pap's smear does not mean that the patient does not have cervical cancer. Although it is a possibility, but its also possible that other factors caused a false-negative result such as the presence of a sampling error, there was poor yield etc. All practical diagnostic methods may be done, including diagnosis of exclusion, which f...
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