EBM Dilemma

I'm on my 2nd week at Family Medicine which is our last week in the department. I'm enjoying every single moment of my OPD duty especially when the resident agrees with my diagnosis and my management. There are always glitches but it feels good when the resident gently discusses the case with me and tells me what should have been done. I'm enjoying my learning experience EXCEPT for this Evidence-Based Medicine shit that I have no knowledge about. I wonder why our school didn't teach us such! Thanks to my blockmate who sent a copy of an EBM self-instruction manual to our yahoogroup. The introduction goes:

Medicine is a dynamic endeavor. Everyday challenging problems

arise, new modalities of treatment are promoted, disease 

management done under minimal or far from ideal conditions etc. 

Because of these challenges the quality of care also changes.  

Suppose a patient who consulted in your clinic with a diagnosis of

dyspepsia is asking for another prescription because the antacid

you previously prescribed was not effective. What will you give H2-

blocker or proton pump inhibitor? Or you may see another patient 

consulting for cough productive of yellowish phlegm who asked for 

a prescription of an antibiotic. Will you prescribe an antibiotic or 

not? These are common problems that may escape our attention 

and diminish the quality of care we give if we make inappropriate 

decisions. 

In the old practice faced with this question, a physician will just ask 

a colleague or an expert for the answer or rely on his/her prior 

knowledge of the disease. He may also prescribe a drug because 

of the promotional lecture he attended previously about the 

product.  

In evidence-based medicine a new paradigm is introduced. Before

he makes a decision, the physician will first try to retrieve his latest 

article about the topic that he kept from his file, appraise the article

then makes a decision. Later, he evaluates the effectiveness of his 

decision. This loop ensures improvement in the quality of care.  

The purpose of this self-instructional manual is to introduce to 

family physicians the concept of evidence based medicine and the 

use of these concepts to improve the quality of his/her own 

practice. 

EBM is real complicated for someone like me who will start from scratch. Formulating a clinical dilemma is non-tedious, clinical appraisal is. 

I'm contented with the pacing of our duty hours: 12 hours at Ambulatory Care, we receive patients from the triage who are not suited for admission. Not toxic in terms of the work load, toxic lang ang history taking and PE! Like you need to include a genogram and you're not supposed to abbreviations! Ayos lang, ganun naman talaga ideally but my hands hurt a lot! Tsaka, ubos na ink ng ballpens ko! 

When we're not on duty, we do OPD works at FamMed OPD, which means we're free on weekends like this. I want to watch a movie tomorrow but I don't know who's available to accompany me. 

We're off to the community in one-week time and I'm cringing at the idea. I just don't like going off. Hmp. 

My mind's clouded. I'm going senti. Need some shut eye.