Come on.

We've gone through four dreadful pre-medical years of learning everything from the composition of atoms to how an apple exerts force when falling off a tree. We've taken a massive exam full of content mostly unrelated to our future field only to be put through four more years of intense medical education (and several additional massive exams). We've managed to earn a medical degree and have gone through at least some postgraduate training.

We've gone through too much academic rigor to sell ourselves short.

So when I hear medical trainees in passing debating clinical management or listen in on a young clinic doc explaining treatment options to a mutual patient, I cannot help but cringe every time I overhear the phrase "studies show."

Used together, these two words should be banned from medical vernacular.

The Problem

When uttering this lackluster phrase, the clinician is declaring:

"There may be a study out there that I haven't read or critically analyzed that may or may not pertain to you and your specific health issues."

Simply put, it's poor form.

Medical professionals need to do better in communicating our confidence (or lack thereof) when questioned about why we decide to do the things we do. If a patient or colleague questions a clinical assessment, we should be clear about how we have come to our conclusions.

If we've read evidence supporting our management decisions, let's own it by truly referring to the literature. But if we are only vaguely aware of research that supports a questioned decision without first taking time to read the evidence and/or supporting editorials and guidelines, let us not sugarcoat our lack of due diligence.

Not all evidence is good evidence.

Published clinical studies may have poor methodology, relate to a cohort different from the patient being cared for or may be superseded by more compelling evidence that demonstrates different outcomes.

By simply declaring that "studies" support our clinical decisions, we run the risk of being misleading to both our patients and our colleagues.

The Solution

There are simple and much more honest ways of communicating our clinical reasoning when being questioned by those around us.

Whether we like it or not, many medical decisions made daily by clinicians are not evidence-based, but rather learned through training and experience. When patients or colleagues question a medical decision of mine that has not been subject to rigorous study, I often refer to my medical training as the guiding source of my clinical judgment. More seasoned clinicians may similarly use their extensive clinical experience as reasonable justification.

It is impossible to read every journal article, and excessive for one to expect all physicians to be reputable experts in critically appraising clinical research. So when I have skimmed an abstract of a specific study published in a highly regarded medical journal, I am not afraid to bring up its existence and the possibility of it supporting my medical decisions. But I am equally careful not to overstate the extent of my knowledge, and often will return to the literature before furthering a discussion with a patient or colleague.

Take Home Point

Those of us in the medical field have worked incredibly hard to get to where we are today. We've successfully tackled an entire new language full of medical jargon and have crammed our heads full of medical knowledge.

We are good at what we do, but we are not experts in every aspect of clinical research.

So let us all stay candid when defending our clinical reasoning by knocking out ambiguous and potentially misleading phrases such as "studies show."

Originally written for LeadDoc.
Brian Secemsky, M.D.

Medical writing for patients, students
and practitioners.

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