One of the challenges of Medicine is allowing for change. Doctors get trained in ways later discredited.  I recall in medical school being told the majority of what we would learn will be either wrong or irrelevant by the time we were physicians – but nobody knows which parts.

Putting down old beliefs and approaches is not as easy as it sounds.  Few doctors change the way they practice readily – somewhat from prudence, as this week’s news may be discredited soon afterwards.** If one is interested in “Truth” and patient care, it does mean biting the bullet and admitting your methods are outdated or just plain wrong.

Take for example the long time time honored once upon a time standard of care of blood letting. As Medicine advanced, blood letting was discarded. However, it only left after a long drawn out fight by those who swore it was useful.

Another example is the treatment of insomnia. When I was in training, insomnia was merely a symptom of something else; treat the disorder and the insomnia would dissipate. Sleeping pills were never indicated for more than two weeks.  All of this is now wrong; I have to watch myself and my approach when chronic insomnia cases come through the office door.

On the flip side. I am wary to recommend treatments for which there is no great evidence to support it.  I realize the placebo effect is vast; if a patient eagerly wants to try – like acupuncture – it will likely work.  Yet, is this year’s “scoff” next year’s “truth” and will become standard of care? How much of what I promote today will be someday replaced or even discredited?

I continually try to keep up with the medical news, particularly in my field of psychiatry, which grows by leaps and bounds.  I have to simultaneously be wary of ‘news flashes’, yet ready to change how I practice if evidence-based medicine tells me to do so.

It keeps me on my toes.

**Vitamin E has gone from ‘good’ to bad’ several times. Right now it is ‘bad’.  I sense Vitamin D, now on the ‘good list’ will drop off likewise. 

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