Smash
Forum Asst. Chief
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We seem to be on a roll with navel gazing threads examining the great questions of Life, The Universe and EMS lately, so I thought I might get in on the act. I've noticed a large muber of posters referring to experience as the gold standard of developing patient care, to the point of same stating that there is no place for statistics in their truck, and a fair degree of suspicion towards EBM in general.
So I thought I would do some navel gazing of my own in regards to why EBM, statistics, science and research is so important in EMS.
Randomness: Human beans are programmed to see patterns. We see a man in the moon, shapes in clouds, or believe that we have runs of luck at the craps table. Whilst this pattern sensing may have been useful in our development, we are now a touch 'trigger-happy' in seeing patterns where there are none. This is why it is so important to have an unbiased view of what is really happening thanks to the wonders of statistics. Due to this we also tend to 'find' causal relationships where they do not necessarily exist.
Regression to the Mean: For EMTs, regression to the mean is an important concept, particularly when administering treatments, or considering the natural history of a disease process. Regression to the mean means simply that most things follow the "bell curve" and that when things are at their most extreme, they have a tendency to settle down again (homeopaths and other quacks and shysters rely on this extensively)
Bias towards positive evidence: For some reason we have an inate desire to find evidence that supports a particular hyopthesis, so we tend to devalue anything that contradicts a hypothesis. For example, if I state "Paramedics are good at intubating" as my hypothesis, I will naturally tend to place emphasis on such evidence that confirms this position and ignore data that refutes it. We see this also in publication bias of papers - papers that confirm a particular stance are far more likely to be published than those that refute it (some see a sinister aspect to this when studies are published by drug companies... and it's quite possibly true)
Confirmation Bias: Added to the above tendency to prefer positive evidence, we have a tendency to actively seek out confirmatory data for a particular hypothesis. So after deciding that "Paramedics are good at intubating" not only do we overvalue confirmatory data, but we actively go looking for more supportive data.
Our Prior Beliefs Bias Us. I believe that this is a big one. We are biased by our prior beliefs (whether they are rational/supported or not) when looking at new things. So the paramedic who has been taught in paramedic school "Paramedics are good at intubating" will find it difficult to accept any other position even in the face of overwhelming evidence. Therefore, when we teach paramedics what to think, rather than how to think, we set up a system of ongoing ignorance of best practice, statistics and evidence.
Social Influences. Our beliefs are strongly influenced not just by the above factors, but also by the company we keep. We place ourselves in situations where our beliefs appear to be confirmed, we seek out only information that confirms our beliefs and downplay or ignore evidence that counters them, and we surround ourselves by people who support and strengthen our beliefs. Therefore in the face of someone who challenges our beliefs (for example by countering the idea that organ transplantation is beneficial to individuals or society) we respond as a pack, not with contemplation of the evidence and rational decision making, but with "OMG! I can believe you said that" followed by a chorus of similar remarks.
So, to recap:
1) We see patterns where there are none.
2) We see causal relationships when there are none.
3) We overvalue confirmatory information for a given hypothesis.
4) We actively seek out confirmatory information for a given hypothesis.
5) Our assessment of the evidence is biased by our previous beliefs.
6) We run with the pack.
Hence the danger of relying solely on our own experience to make judgements or plan treatments for real patients, and the danger of considering everything we were told in school as "true"
"The real purpose of the scientific method is to make sure that nature hasn't mislead you into thinking you know something you actually don't know" Robert Prisig
So I thought I would do some navel gazing of my own in regards to why EBM, statistics, science and research is so important in EMS.
Randomness: Human beans are programmed to see patterns. We see a man in the moon, shapes in clouds, or believe that we have runs of luck at the craps table. Whilst this pattern sensing may have been useful in our development, we are now a touch 'trigger-happy' in seeing patterns where there are none. This is why it is so important to have an unbiased view of what is really happening thanks to the wonders of statistics. Due to this we also tend to 'find' causal relationships where they do not necessarily exist.
Regression to the Mean: For EMTs, regression to the mean is an important concept, particularly when administering treatments, or considering the natural history of a disease process. Regression to the mean means simply that most things follow the "bell curve" and that when things are at their most extreme, they have a tendency to settle down again (homeopaths and other quacks and shysters rely on this extensively)
Bias towards positive evidence: For some reason we have an inate desire to find evidence that supports a particular hyopthesis, so we tend to devalue anything that contradicts a hypothesis. For example, if I state "Paramedics are good at intubating" as my hypothesis, I will naturally tend to place emphasis on such evidence that confirms this position and ignore data that refutes it. We see this also in publication bias of papers - papers that confirm a particular stance are far more likely to be published than those that refute it (some see a sinister aspect to this when studies are published by drug companies... and it's quite possibly true)
Confirmation Bias: Added to the above tendency to prefer positive evidence, we have a tendency to actively seek out confirmatory data for a particular hypothesis. So after deciding that "Paramedics are good at intubating" not only do we overvalue confirmatory data, but we actively go looking for more supportive data.
Our Prior Beliefs Bias Us. I believe that this is a big one. We are biased by our prior beliefs (whether they are rational/supported or not) when looking at new things. So the paramedic who has been taught in paramedic school "Paramedics are good at intubating" will find it difficult to accept any other position even in the face of overwhelming evidence. Therefore, when we teach paramedics what to think, rather than how to think, we set up a system of ongoing ignorance of best practice, statistics and evidence.
Social Influences. Our beliefs are strongly influenced not just by the above factors, but also by the company we keep. We place ourselves in situations where our beliefs appear to be confirmed, we seek out only information that confirms our beliefs and downplay or ignore evidence that counters them, and we surround ourselves by people who support and strengthen our beliefs. Therefore in the face of someone who challenges our beliefs (for example by countering the idea that organ transplantation is beneficial to individuals or society) we respond as a pack, not with contemplation of the evidence and rational decision making, but with "OMG! I can believe you said that" followed by a chorus of similar remarks.
So, to recap:
1) We see patterns where there are none.
2) We see causal relationships when there are none.
3) We overvalue confirmatory information for a given hypothesis.
4) We actively seek out confirmatory information for a given hypothesis.
5) Our assessment of the evidence is biased by our previous beliefs.
6) We run with the pack.
Hence the danger of relying solely on our own experience to make judgements or plan treatments for real patients, and the danger of considering everything we were told in school as "true"
"The real purpose of the scientific method is to make sure that nature hasn't mislead you into thinking you know something you actually don't know" Robert Prisig