Concepts of Information Mastery

Concept 1: Patient-Oriented Evidence that Matters (POEMs)

A POEM is information that helps clinicians to help patients live longer and better. It is direct evidence that a medical intervention, on average, lengthens life, decreases symptoms, and/or improves life quality.

POEM information contrasts with “disease-oriented evidence,” information about the nature of disease and treatments that does not directly demonstrate improvement in patient-oriented outcomes. The distinction is important since there are numerous examples of disease-oriented evidence that are contradicted by POEM information.

Disease-Oriented Outcome

Patient-Oriented Outcome

Antibiotic treatment can sterilize the middle ear of children with acute otitis media.

Antibiotic treatment does not decrease the duration or intensity of symptoms and increases the likelihood of a subsequent episode of acute otitis media.

Intensive glucose lowering can decrease A1c, blood glucose.

Intensive glucose lowering does not decrease mortality.

Beta-carotene and vitamin E are good antioxidants.

Neither vitamin prevents cancer or cardiovascular disease.

Erythropoeitin in patients with chronic renal failure increases hemoglobin.

Erythropoietin increases mortality in patients with chronic renal failure.

Varenicline can help some patients stop smoking.

Varenicline increases the likelihood of cardiovascular disease.

While disease-oriented evidence is important for forwarding medical science, changing practice based on this preliminary evidence may result in causing harm to patients.

Article: Becoming a Medical Information Master: Feeling Good About Not Knowing Everything

Concept 2: The Usefulness Equation

Just as all medical information is not equally important, so too is there a difference between sources of information. The Usefulness Equation relates three attributes of information sources:

Usefulness of any info source = Relevance of info x Validity of info
                                                           Work needed to obtain info

Relevant
information is applicable to one’s practice and is also focused on patient-oriented evidence that matters.

Validity is where evidence-based medicine techniques are helpful. Differences in study design and study conduct influence our comfort in the validity of the results.

Work is the time, energy, and money needed to find the needed information. A benchmark for low work is that answers can be found in less than one minute.

Article: Becoming a Medical Information Master: A Guide to the Information Jungle

Concept 3: Two Tools Are Needed to Become an “Information Master”

Tool #1: An information resource to hunt for information at the point of care

Tool #2: A "keeping up" resource that finds and presents new research findings that are both relevant and valid

Concept 4: “Clinical Jazz”

“Clinical freedom implies doing what is best for patients, not simply doing whatever the clinician wants.” - North of England Guidelines on the Treatment of Asthma

Clinical jazz is a mix of the structure provided by the best available evidence coupled with the clinical experience necessary to understand what each patient needs.

Article: Clinical Jazz: Harmonizing Clinical Experience and Evidence-Based Medicine

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