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Experience Vs Guidelines

Posted 8/6/2013

Posted in

  I can imagine the sighs of relief that I have found a new topic. And this is a really (to me, anyway) interesting one. What is the right balance of experience vs data driven science? As medicine increasingly moves towards guidelines and clinical pathways (meaning a map of how to do things), there is less wiggle room for clinicians. One reason that many of us, myself included, like doctors with a little gray in their hair and a few wrinkles on their faces is that they have gained experience and, hopefully, wisdom.

  Some people, I know, prefer young doctors, feeling that they are up to date on everything new and more likely to be open to breaking ideas. I don't think that is wrong, but I suspect that the best doctors, whatever their ages, share that willingness. As a parallel, one excellent thing about my own profession is that it helps to have gray in my hair and wrinkles. People are generally reassured that an older clinician has some life experience and balance--as opposed to a really smart 25 year old who just can't have lived enough to truly "get it".

  That is background musing to this essay from The Breast about recent experiences at the St Gallen Conference on Early Stage Breast Cancer. This takes place in St Gallen, Switzerland every two years and is a chance for scientists and physicians from all over the world to come together and talk about breast cancer research and care. I suspect that both the dialogue and the surroundings are pretty terrific.

  Here is the beginning and then a link:

There are strengths to the focus on clinical expertise and

consensus. St. Gallen has always been a decidedly international



all the major European countries are represented, along


with Americans, Canadians, and a growing number of Australasian

nations. The simple truth is that there are substantial regional variations

in approaches and access to breast cancer treatments, even

in developed countries. This is especially true regarding resource

intensive management needs, such as molecular diagnostics, radiological

imaging and radiation treatments, and newer drug therapies.

In a moment of candor during panel debates on the value of

multigene diagnostic assays vs traditional pathology, it was

acknowledged that patients and doctors in many countries lack access

to such testing. They may have access to different resources







in this case, traditional pathology


that can be interpreted to good


effect for many. Such are the realities of medical practice in a world

where information is shared globally, but access to medical tools is


In additional to savoring the international flavors


, St. Gallen still


cherishes clinical intuition. How refreshing it is to hear a doctor say



most of the time, I do this but here, I wouldntor I understand


that the patient needs this done


or I know the data arent


strong but I think it is worth considering.


These are not the whimsical


choices of rogue clinicians. They are the reasoned selections by

seasoned experts who have cared for thousands of patients, participated

in hundreds of clinical trials, and understand that not every

situation can be scripted ahead of time, or always


!t the results of


phase III studies, or match the emotional or clinical needs of a given


( If you have trouble with this link, email me)


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