Six accepted ED practices that are potentially harmful, costly, inefficient, or just don’t work
I’m always a bit tickled (yes, I said tickled) by the lofty discussions about evidenced-based medicine when much of what is done in medicine and many things we do in emergency medicine have little supporting evidence. It seems that our focus is the evolution of current management and diagnostic strategies and developing research strategies to prove or disprove our hypotheses. Although asking new questions and adding new literature to the world’s research database is critical to the evolution of medical practice, what is easier and more critical is questioning what we already do based on evidence that already exists. In other words, we might be asking the right question at the wrong time—or the wrong question altogether.
As much as we claim to be scientists and practice with evidence as our guide, much of the care that is delivered in emergency departments comes from folklore. We have all—present company included—practiced in ways we absolutely believed to be best practice only to find out later that we may have been wrong. Hey, you don’t know what you don’t know.
There is great value in learning from great educators. However, we can get lost in the “greatness” of our mentors. Many edicts in medical education were taught to those we trust today by those whom they trusted yesterday. Once a learned, respected colleague states a “fact” with confidence, it often becomes unchallenged evidence and is passed down from one generation to the next. Evidence of my lack of social life, I enjoy using the “hot-tub time machine,” revisiting the land of lost medical questions to see if today’s evidence still supports these previously “answered” questions. It is amazing what you can find when you look.