Author's reply

Editor - Yamey's comments on our article are somewhat mystifying. We wonder if his concerns arise from incomplete reading, or from a misunderstanding of our purpose in writing this series.

Firstly, of course we would not advocate giving "litres of fluid or blood" to a patient who has had a cardiac arrest secondary to left ventricular failure or cardiac arrhythmia, which is why this advice on resuscitation is clearly part of a section on the management of ruptured abdominal aortic aneurysm. We stand by our advice on aggressive fluid resuscitation in this circumstance.

Secondly, this article is aimed at students graduating to their first house job. Surely Yamey does not believe that students/house officers could reliably and objectively assess all the evidence applicable to every clinical scenario that they encounter? Furthermore, not all evidence is good evidence, and clinical experience is often needed to tell the difference. Therefore, unlike Yamey, we see no inconsistency in seeking to combine an awareness of the best evidence available with the advice, experience, and preferences of senior colleagues. We see value in hierarchy, and believe that junior doctors should not be hasty to dismiss the counsel and preferences of their senior colleagues.

Adam Jones, specialist registrar in Urology, research fellow in Urology

Kevin Turner, Department of Urology, Churchill Hospital, Headington, Oxford OX3 7LJ


studentBMJ 2000;08:175-216 June ISSN 0966-6494