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Introduction
Where Physicians Get Information
There are four main types of information. Some are very reliable;
others are less reliable. That is to say, you can put more faith
in some types of recommendations than in others. When your physician
makes a recommendation, as what information she or he has used as
a basis for that recommendation. The following are the questions
to ask about different types of information:
"Are your recommendations based on medical tradition?"
There is nothing wrong with medical tradition, but it is only as strong as saying "we always do it that way." Some traditions such as caring, confidentiality, or respect for privacy will probably never change. Other traditions should be challenged. An excellent example is that of routine abdominal perineal resection where the anus is always removed with rectal cancers. Only when the tradition was challenged did surgeons learn how to save the rectum or make a new rectum.
"Are your recommendations based on personal experience?"
If you see a specialist who has seen many cases like yours, then her or his experience probably has some validity. However, you can understand how valuable your physician's experience will be for you only if you ask about that personal experience. Ask how many persons your physician has seen who are like you.
If you have a rare condition or situation, then even a few persons in the past is relatively a lot, but if you have a common situation, you would not rely on your physician's personal experience unless he or she has seen many persons with similar situations.
If your physician is a generalist, or even a specialist, there are frequently better ways to make decisions and give you recommendations. Personal experience traditions are appropriate basis when there are no other sources of information.
It is also important to not only ask your physician how many cases he or she has seen, but also whether they have reviewed the outcome of their results. Physicians who have looked at their cases, reviewed their outcomes and critically analyzed them will have the best understanding of their experience.
"Are your recommendations based on reports of the care of large numbers of patients?"
Much better advice for you is based on a large past experience with individuals in similar situations. The way a physician gets access to a very large experience is to read many articles in which other physicians report their experience with similar groups of patients.
If your physician has published a formal article on a particular aspect of the information she or he has given you, this will also be valuable, but only as a part of a published experience of physicians who have looked at similar groups of patients.
Typically, a physician will publish an article about a group of patients evaluated or treated in a certain way. Such a group of patients is sometimes called a "series" to indicate that they were a group of patients treated serially, i.e. in the order they arrived, within a certain time period and in a certain way.
For most aspects of colon and rectal care, it is important to have enough patients in the series for it to be reliable. Another term to be equated with reliable is "statistically significant." It is also important to have follow-up on such as a group of patients for a long enough time that one can really know what to expect, not just next week, but in five or even ten years from now.
"Are your recommendations based on a randomized clinical trial?"
A randomized clinical trial is the best way to compare two or more ways of diagnosing or treating cancer conditions. It is impossible to compare patients treated in each way were not similar before the treatments were given.
In a randomized clinical trial, similar patients are divided into two groups. Each group is assigned to a different treatment. This decision is not due to the choice of an advocate of one specific treatment, but by chance. In this way, the groups are as similar as possible and you can readily understand the effective treatment. Such a process eliminates bias, or the selection of patients with less dangerous cancer, or the physician's favorite treatment.
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