Given Baby P/Shipman whats more important, evidence based medicine or admission ?

[BeanOfJelly]

I'm going to bed now. I concede the argument. Congratulations. You win.

[NorthernLight]

Clearly, unless 4th year medics, who will become doctors when they grow up, think then they will also 'not look for evidence' because it hasn't been done before. They see no reason to suspect that something may be going on.

It's always good when somebody throws thinly veiled insults rather than actually responding to what has been written.
If you think that potential doctors should be tested and screened more carefully before gaining a place in Medical School, then argue your case. Picking Harold Shipman and the case of Baby P as examples of how the current system is utterly inadequate seems flimsy "evidence" to me - unless you have evidence of systematic Shipmans who are currently getting away with murder, or hundreds more Paediatricians who are allowing vulnerable children to die at the hands of abusive parents/carers then the only one of us who needs to "look for evidence" is you, because you've not given me very much so far.

[ipsiLoquitor]

LOL - if you knew me you would know that courting popularity is not my modus operandi.

I wonder if you'd mind doing a 'thought experiment' with me. Consider yourself to have got into medical school, become a doctor and been appointed to investigate alternative ways of handling the recruitment process: what will you do ? What are the problems and your solutions ? What criterion do you want met and how will you protect patients ?

[ipsiLoquitor]

Someone like me doesn't consider to have 'won' or 'lost' an argument. De Bono's methodology is more like mine. If you read this again with an open mind you might consider things again:
Some interesting nonsense going on here, mainly predicated on lack of intellectual rigor.

If a doctor performs no examination/investigations, she has no results and no evidence i.e. no evidence base. This is the mistake in the Baby P case.

And what is happening here ?

Some commentators are doing exactly what the doctor in that case did - they are citing 'no reason to look' and 'no evidence given' as no reason to look. Is it not clear that this is what the doctor in that case said.

Does any one of you claiming 'naivety' know of any research in the area I have been discussing ? And isn't research/evidence based medicine the kind you are supposed to be practising ?

Clearly, unless 4th year medics, who will become doctors when they grow up, think then they will also 'not look for evidence' because it hasn't been done before. They see no reason to suspect that something may be going on.

Surely a congruent and ethical position here would be to admit the lack of research and to admit 'I don't know because I don't have information'. Once that admission, painful for most doctors, is made then there is some cognitive room to discuss the appropriate research methodologies and improvements that can be made.

Also missing is your antonym ? What is the opposite of naieve ? If I qualify for that label will my opinion be more or less valuable ?

Really, when a doctor doesn't know or has no evidence if they just admit it, they are in a position to practice ethically. Isn't it still a requirement to 'know the limits of our competence' ?

[ipsiLoquitor]

Fair few questions there. All unanswered. Good night.

[Clarkey]

I would like to know what the OP's (original poster) background is and if they have any evidence available online that people can read that backs up their arguments.

[Doc Skin]

Is it the people with the highest IQ's that make the best doctors? Being a doctor is as much about being a good communicator as it is about having the intellectual ability.

How anyone could not recognise this toddler's abuse is difficult to comprehend, a bit of chocolate smudged on the face might hide a few bruises but what about missing finger tips and finger nails? The broken back, he was paralysed from the waist down! Surely it wouldn't require intense investigation for someone to realise something was wrong?

[ipsiLoquitor]

Oh, OP is original poster. I had assumed from the comments that it was Outpatient.

Thank you. Both reasonable requests. The background question I will leave until later because of some of the lack of response to my questions e.g. the opposite of naive - and the subjective valuations placed upon my views which seem to be related to perceived status rather than quality of input.

There is a lot of evidence available on many aspects of this - quite a bit of which is available on google scholar. But if you are generally interested, as one specific example of predictive psychodynamic evaluation have a look at diagnostic transactional analysis. There is also an enormous amount of psychological research which simply hasn't been applied yet.

The underlying assessment/acceptance process itself is, relatively speaking, minimally researched and what I have found appears to have been constrained by prevailing attitudes and paradigms.

Let me know if you are interested because I do have filed away somewhere a list of sources and one or two things that you won't find in a library.

[ipsiLoquitor]

On communication: of course this is important. But what if the prospective student is an expert and exhibits what are commonly agreed to be excellent communication skills: isomorphic metaphor, nonverbal pacing, matching predicates etc. A qualified consultant with no experience in this area may mistake mataphorical linguistic technique with 'psychotic' symptomatology because of the 'literal' test. Unless the groundrules are agreed and the 'expert' provides advanced notice she will be rejected on 'gut instinct' combined with partial psychiatric knowledge.

In the case of Baby P. I would suggest that the doctor could have passed with flying colours as a previous poster suggested an entrance tests and have 5 A* A-levels if that is what they are nowadays. However, communication skills are not the same as dynamic assessment of communication. She was definitely not psychodynamically assessed because this is not routine even when dealing with children let alone when applying for med school.

[ipsiLoquitor]

In response to your question 'surely it wouldn't take intesne investigation' ? Perhaps not, but as a minimum it would take someone who maintained an open mind and didn't need the proof providing by the abusive party.