Dr Phil Hammond, GP, lecturer and presenter of BBC2's Trust Me, I'm a Doctor

Evidence-based medicine – boring!

What do you mean, boring?

Well it is, isn't it? And time-consuming. Where am I going to find time to convert my information needs into answerable questions, track down the evidence, critically appraise it, apply the results and evaluate my performance?

Well, at least you know what evidence-based medicine is.

Of course I do. I've had it rammed down my throat at every education meeting I go to. The point is that I don't have the inclination or the energy to go wading through the internet to find the best treatment for heavy periods.

So what would you prefer?

A visit from a shapely pharmaceutical rep to massage my ego and pepper me with Post-it notes.

Don't you think her view might be slightly biased?

No. I only see reps from reputable research-based companies and I trust their information.

OK. So what do you prescribe for heavy periods?

I prescribe norethisterone.

Yes, and so do 38% of GPs, making it the most commonly used drug and costing the nation £654,538 a year.

There you go. We can't all be wrong.

But when we look at the evidence, we find that norethisterone used at low doses and for short durations isn't very useful in reducing blood loss.

So you're saying 38% of GPs are stupid and prescribing the wrong drug?

No, I'm saying...

I'm going to have to speak to my lawyer about this. Slandering doctors is a very serious business.

All I'm saying is you're probably still prescribing what you were taught to prescribe 20 years ago, and that medicine has moved on a bit since then.

So, I'm an out-of-date old git?

Yes.

That's OK. Just don't call me stupid.

I wouldn't dream of it. But I do think you should switch to tranexamic or mefenamic acid for heavy periods.

Says who?

Says the NHS Centre for Reviews and Dissemination at the University of York.

I see. These ivory tower academics north of Watford are clubbing together and telling me what to prescribe, are they?

Not at all. This study was done by researchers across the country who assimilated the best available evidence for people like you who haven't got the time to find out for yourself.

Yes, but they're still threatening my clinical freedom.

No. You're still there to take histories and examine patients, and if you don't do that properly, EBM is useless. But if you do it well, EBM can ensure you order the most appropriate tests to reach a diagnosis and instigate the most effective treatment.

Where does that leave my curries?

Sorry?

If I'm going to be sent unbiased up-to-date clinical guidelines telling me what to do, then will attractive women still come to my surgery and tempt me to prescribe something else?

I'm not sure. I hadn't thought of that.

Well think on. EBM could mean the death of reps. And no reps means no freebies...

Nope. No free pens, no books, no stress relievers, no juggling balls…

EBM...what a load of pants, eh?

Yes, but a clear conscience.

  • Trust Me, I'm a Doctor, the fourth series (on BBC2) and the book (published by Metro), are out in February 1999.

Guidelines in Practice, January/February 1999, Volume 2
© 1999 MGP Ltd
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