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Clinical Skills

The Essential Elements of Evidence Based Clinical Practice

What are the essential elements of evidence based clinical practice? By now everyone has heard the definition of evidence based practice as the integration of current best evidence with clinician expertise and patient values. The actual quote is: “Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making...
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Publication Bias

I’ve just read a fascinating piece of hard-hitting investigative journalism, the book “Bad Pharma” by the medical provocateur Ben Goldacre (Goldacre B. Bad pharma: how drug companies mislead doctors and harm patients. New York, NY; Faber and Faber, 2013). You might know of him from some of his TED talks, wherein he demonstrates how...
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An evidence-based diagnostic aid

Clinical trials focused on treatment for patients with low back pain (LBP) typically classify patients into few diagnostic categories. Often, after LBP from pathological conditions is ruled out, patients are labeled only with “non-specific LBP.” The generic diagnosis is a repetition of the symptom, and makes it difficult to understand how patients in clinical...
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Back to Basics: Horses and Hooves

I know it’s a cliché, but writing a case report is “just like telling a story.” That is not entirely true, but in that spirit, I would like to tell a short story about a patient I saw a few weeks ago. This was a 69 years old male patient I have been seeing...
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McMaster University EBCP Workshop

What an exhilarating, enlightening and absolutely exhausting experience. I have just finished my role as a first time tutor at the McMaster Evidence Based Clinical Practice workshop in Hamilton, Ontario. The McMaster EBCP workshop has been going on for decades. It is an intensive 5 day program for health care educators and practitioners that...
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Chronic Pain: another component

There is growing evidence showing that brain structure can predispose a person to chronic back pain following an injury. In a series of studies, researchers in Chicago IL identified differences in structural connectivity between different areas of the brain. Differences were measurable in a manner that allowed the prediction of patients likely to develop...
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Book Review: etc.

Donald Murphy has written a book entitled Clinical Reasoning in Spine Pain, Volume I. He authored most of it himself but there is contributed material from Gary Jacob, David R, Seaman, and Steven Heffner. About half an hour after receiving the book on Feb. 13, 2014, I sent Don the following email: “Book just...
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A Different Take on Orthopedic Testing: Using Sensitivity and Specificity

So, let me ask you a question. If someone told you that they had a disc prolapse at L5 that was, according to the MRI report, “large enough to completely occlude the left IVF at L5,” what kind of picture would your mind’s eye consider? What would you expect to see during a physical...
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Caregiving 101

I recently read an article highlighting the role nurses can play to reduce the suffering of patients with chronic pain(1). The article cites studies showing how motivation, listening, encouragement, and camaraderie provided by nurses and others can greatly relieve psychological distress and influence how patients with chronic pain deal with and adapt to their...
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The Evidence-Based Approach, in Brief

Evidence-based practice is predicated upon an approach to information assessment known as the 5 As. This stands for: Ask, Acquire, Appraise, Apply and Assess. Let’s look at this in the context of an actual patient encounter. Let’s begin with you seeing a patient whose problem lies outside your area of expertise and knowledge. Perhaps...
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