Richard Lehman on Evidence Based Medicine

Richard and Raj discuss Palliative care

Richard and Raj discuss some of the History of Statistics, and how it informs the practice of EBM today.

Richard and Raj discuss how patients can be involved in the process of generating evidence, from determining patient centered outcomes to prioritizing types and goals of research.

Richard & Raj discuss decision making in EBM, and the tipping points that change clinical practice.

Richard & Raj discuss Overdiagnosis, starting with the difficulty of defining the term to the practical challenges in every day clinical practice. Links on Overdiagnosis: https://www.bmj.com/content/344/bmj.e3502 https://academic.oup.com/jnci/article/102/9/605/894608

References: 1. Wilson JM, Jungner YG. [Principles and practice of mass screening for disease]. Bol Oficina Sanit Panam. 1968;65(4):281-393. 2. Mant D, Fowler G. Mass screening: theory and ethics. BMJ. 1990;300(6729):916-918. doi:10.1136/bmj.300.6729.916 Discussion Timestamps: 0:15 Population Health and Screening History 6:44 Population Health Math 11:41 Screening for Blood Pressure 13:36 Wilson Criteria Difficulty 15:09 Blood Pressure and Screening Programs 22:10 Prostate Cancer Screening 28:27 Colon Cancer Screening 30:06 Colonoscopy Higher Rates of Adenoma Detection

Richard and Raj discuss the potential future role of AI in EBM and medicine

James Mccormack, from https://therapeuticseducation.org/ , discusses personalized, one-agent-at-a-time approach to medication management.   He also has helped to create several decision based websites:   Overall CVD cvdcalculator.com Heart failure https://hfmedchoice.com/ Diabetes https://decisionaid.ca/diabetes/

Richard and Raj discuss the history of Hypertension and how it lead up to modern day challenges of managing high blood pressure.

The NNT

Reference: https://gpevidence.org/

richard and raj discuss the changing approach to managing diabetes over the years.

Richard and Raj discuss the role of meta-analysis in EBM, in light of the recent controversial cochrane report on masks (physical interventions) in respiratory infections.

Richard and Raj discuss personalized medicine in primary care

Richard and Raj discuss common challenges and errors that may occur in diagnostic reasoning. Reference: https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2923.2009.03507.x

Richard and Raj discuss the cognitive process of diagnosis, and reflect on the different ways physicians make diagnosis beyond the standard approaches taught in EBM.

Raj and Richard continue their discussion on Diagnosis

References: Diagnostic strategies used in primary care. BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b946 (Published 20 April 2009)Cite this as: BMJ 2009;338:b946

1. Lehman R, Tejani AM, McCormack J, Perry T, Yudkin JS. Ten Commandments for patient-centred treatment. Br J Gen Pract. 2015;65(639):532-533. doi:10.3399/bjgp15X687001 https://bjgp.org/content/65/639/532 2. Yudkin JS, Lipska KJ, Montori VM. The idolatry of the surrogate. BMJ. 2011;343(dec28 1):d7995-d7995. doi:10.1136/bmj.d7995 https://www.bmj.com/content/343/bmj.d7995

A discussion on Heart Failure, polypharmacy, and optimizing therapy with multiple medications.

Is EBM dead? This was a common claim the 2010's, but the response to the Covid pandemic lends some optimism that EBM is has some life yet! Join us as RIchard discusses the rise of EBM from 90's to the 2020s.

Richard discussed the concept and complexity of making shared decisions with patients. Or as he prefers to describe it, a "shared understanding of medicine".

Richard Lehman discusses the practice of primary care before EBM, and why EBM was necessary for medical practice to progress into a new era.

Introduction to the podcast, where Richard Lehman and Raj Mehta discuss EBM topics.