1. Patient-Oriented Evidence
- mortality, morbitiy, quality of life
- live longer and/or better
2. DOE: Disease-Oriented Evidence
- Pathophysiology, pharmacology, etiology
3. Patient-Oriented Evidence that Matters (POEM)
- It matters to you and the clinician, because if valid, it will require a change in practice.
Validity always comes down to probability. How many studies does it take? There is no absolute truth in the world of information. What is the level of probability that will cause people to change their behavior.
Traffic light anology - most of the information in medicine today is in the yellow light (benefit / harm uncertain). Doctor's need to keep an open mind.
"I know a lot, therefor I am"
- Replaceable by a computer.
"I think, therefore I am"
- Never replaceable by computer.
- People are going to start not trusting a doctor who won't use computer.
Hand held computer = stethoscop of the future.
Levels of information mastery -
Level 0 - making decisions by guessing or being influenced by drug reps.
Level 1 - hunting and foraging tools.
Level 2 - people who create foraging tools for level 1.
Level 3 - people who do the original research or do systematic review.
We really only need to get most people to Level 1.