Worrying advice to medical students
Editor - Jones et al give some excellent guidance to medical students on how to manage abdominal emergencies.1 However, I have two concerns about their advice.
Firstly, they state that it is appropriate to give litres of fluid or blood to a patient who has had a cardiac arrest or has an unrecordable blood pressure. Do they really advocate such treatment for hypotension or cardiac arrest as a result of left ventricular failure or arrhythmias?
Secondly, they use language that takes medical students back to the old world, in which evidence didn't matter, hierarchies ruled, the pancreas needed "resting," and many such myths permeated medicine. If students ask for a lateral decubitus film, they'll end up "looking slick," will they? But will they make a more accurate diagnosis? They state that there is evidence that imipenem is the most effective antibiotic in pancreatitis, yet they advise students to find out what your consultant's preferences are. This is surely inconsistent. The great strength of evidence based medicine is that it is a democratising force. All of us - medical students, nurses, policymakers, and doctors of any grade - can use it to aid our decision making. There is still a place for expertise of course, for the experienced clinician knows how and when to apply the evidence to individual patients.2 But the days when we just relied on "the boss" to utter some magic words on the ward round are, hopefully, well and truly behind us.
Gavin Yamey, editorial registrar, BMJ, Worthing Hospital, Worthing, West Sussex BN11 2DH
studentBMJ 2000;08:175-216 June ISSN 0966-6494
- Jones A, Turner K, Handa A. Surgical emergencies: acute abdominal pain (part 2). studentBMJ 2000;8:98-9. (April.)
- Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ 1996;312:71-2.
