My Favorite Articles
Introduction to Series
During my residency, I fell in love with critically appraising the medical literature. The activity combines medical knowledge, some biostatistics, and a pragmatic pay-off -- either improved medical care or the high of figuring why the conclusions of an article are flawed and should be ignored.
Critical appraisal ended up being a launchpad for my academic career. Soon after joining the faculty at the University of Chicago, I started working with Dr. Diane Altkorn running sessions to teach our internal medicine residents critical appraisal skills. The next year I joined Diane, Scott Stern, Wendy Levinson and Keith Roach putting together an “Update in General Internal Medicine.” We reviewed articles all year long to produce a document, article, and talk summarizing the articles published each year that truly changed the daily practice of general internist.[i] This project left me with skills, colleagues, lines on my CV, and a bit of a national reputation.
Diane and I went on to develop a course, Critical Appraisal of the Landmark Medical Literature, that I still offer to our fourth-year students. This course remains the highlight of my teaching each year.
Scott, Diane, and I built on our work to author a textbook, Symptom to Diagnosis: An Evidence Based Guide. One of our goals for this textbook was to teach clinical medicine in way that was firmly founded on evidence-based medicine.
Vinay Prasad and I teamed up in the 2010s to explore how adopting of practices that are not adequately evidenced-based frequently results in Medical Reversal. This work led to an array of papers and culminated in our book Ending Medical Reversal.
About the same time we were finishing EMR, I developed a course for our first-year students, Medical Evidence, which focused on where medical knowledge comes from: what are our questions; how we answer them; and how we end up with good (and sometimes bad) medicine.
I take you through this mini CV to say that I’ve spent a lot of time thinking about the medical literature. Most things I read don’t affect my practice -- they are either unrelated to what I do or seem like they are important until I read them closely and recognize the flaws.
Then there are the articles that stick with me. These are trials that changed my practice the day I read them. These are observational trials that go after important, but difficult to answer questions. Some of these articles changed the way I counsel patients or paved the way for clinical trials. There have even been essays, so well argued that they change the way I think. There are also a few flawed articles that make a mistake in such a memorable way that they help me to read better in the future.
On Sensible Medicine I have been incredibly fortunate to team up with a few like-minded people who share my obsession with the medical literature. Starting next we will begin an occasional series in which we share some of our favorite articles. We will talk about why we find each article compelling and important. For some readers, being reminded of these articles will be a walk down memory lane. For some, they might leave thinking, “huh, so that is why we do that.” Maybe, hopefully, some people will learn some medicine and some critical appraisal skills along the way.
[i] I still recommend that trainees try to establish similar groups. They are an amazing way to master the current literature.
Please do a (critical) appraisal of medical literature for dental x-rays!!!
I tried to find RCTs to support my dentist's recommendation that I get prophylactic x-rays despite being healthy and having no symptoms. I couldn't, nor could my dentist. But his staff still gawk at me like I'm an alien for questioning the virtues of prophylactically radiating my cranium without an objective evidence base.
I'd love to know if such an evidence base actually exists...
Employing critical thinking sounds marvelous in all phases of life. It is like living in a survival mode where you don't get tricked by vested interests who only care about themselves. I don't think big pharma and the AMA are down with critical thinking because it would expose the tremendous corruption that now pervades the medical system. Good luck though.