[HSF] Are we Drs. of medicine or just bachelorates?

[Tea Acuff]

I found this "test" quite provocative, and would encourage everyone to take it. However, rather than look for the correct answer, ask why it is that the test says that there is no "correct" answer. That is, rather than just asking whether the data is most correct in a particular answer, step back and ask why there are different correct answers or conversely no correct answer at all.
 
Although this is an open question on my part and would like as many comments as possible, brief or more detailed, I would suggest at least two ways of looking at this "test" or the issue of why there is no "correct" answer.
 
First, is it merely a technical problem that there is no correct answer? That is, there is a specific and particular correct answer, but just because we can not measure exactly or need one more test or one more RCT we can not come to the correct choice. If we could do this technically correct every educated one would agree with the obviously correct answer. The three answers would all slide into the same place in the puzzle.
 
Second, there is a fundamental error in the process that prevents a correct determination no matter how precise the measurements or what the appropriate approximations. This may be an incapacity of the observer or a plasticity of the observed, or both but some fundamental limitation will always cause a varieties of answers that are not specifically either correct or false.
 
Please also note that it is possible to have a practical limitation of the first (technical) cause that would lead to the practical occurrence of the latter fundamental cause. That is, a full study for example of the proper use of plombage verse PTX for TB  and all its considerations might have taken longer than the life of these therapeutic solutions. This would make the lack of a definitive answer practically speaking a fundamental problem, even if does rule out the possibility of having both true and correct answers for other clinical problems either in the past or future.
 
Take the test or retake it thinking about this issue and how the different treatment answers used the "same" information that baccalaureates are asked to know but not rethink. It represents some of the thematic problems that I have discussed elsewhere concerning the use of our EBM, guidelines, or surgeon restriction and training.
 
Thank you Dr. Cheema for the interesting query. Why does anyone think that the NEJM would ask such a question anyway? To raise the questions that I am asking?
 
tea


 
----- Original Message ----
From: "Faisal H. Cheema, M.D." <fc2020 at columbia.edu>
To: OpenHeart-L at lists.hsforum.com
Sent: Friday, October 26, 2007 10:34:53 AM
Subject: [HSF] NEJM link for casting vote on CAD patient management

I just noticed that the link didn't go through properly in the last email.
Here I am re-pasting the link, hope it works this time around:

http://content.nejm.org/cgi/content/full/357/17/1762

If it still does not work, then please go to: http://content.nejm.org/ and
then you'll see the topic right in the middle of the page.

Best regards,
Faisal



Alternatively you may want to click here: 

http://click2.nejm.org/cts/click?q=137%3B66792468%3BLe74He1rQ0vER2riPfQhdFGI
N%2F7VBX%2FObLO2sYiMaiU%3D





----------------------------------------------------
Faisal H. Cheema, M.D.
Associate Research Scientist
Division of Cardiothoracic Surgery
College of Physicians and Surgeons of Columbia University - New York
Presbyterian Hospital,
MHB 7 GN 435, 177 Fort Washington Ave, New York, NY 10032
Office: (212) 305 5108, Pager: (917) 899 4698, Fax: (212) 342 5309, Cell:
(917) 499 5115



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