EBM CQI Article of the Week 3.7.2021

Doubt – Part One

A student is someone who thinks otherwise.

RL Day

You can prove almost anything with the evidence from a small enough segment of time,….the answer of the minute is positive,….the hour qualified,…. the year contradictory.

EW Teale

The proof that natural philosophy [science] has little truth in it, is that it has only succeeded in things remote, as in the heavenly bodies, or minute as light.

David Hume

Imagine a loved one is living a complicated pregnancy and is referred to a perinatologist.  According to the attached review by Brock et al, only 15% of official recommendations from the Society for Maternal-Fetal Medicine are supported by high-quality evidence.  Nobody respects the complexities that our sisters and brothers in SMFM face daily any more than I,….but 15%?

Neonatology might be marginally better,……Pediatric ICU medicine ditto,……Pediatric oncology probably better because of RCT commitment.  We do well to heed Baruch Spinoza (the primary Virtue is to understand) when our patients resist our “expertise”,…..simply because we often don’t have adequate evidence. 

I try to read a bit of David Hume every day, he is a phenomenal contributor to scholarship, empiricism, and compassion,….the latter is not widely appreciated. 

How perfect is his thought derived from intense study?  1742 or March 2021?

Joe Kaempf, MD

District Represenative, Oregon

Portland, OR

Volume 13, Number 7

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