Why we need evidence-based health care



why do we need evidence-based healthcare let me just give you an example of the saga of King Charles a second I know you don't have too many kings you know it but it's I guess our Kings are kind of like your president is that how that works I'm not sure so I'm just gonna recount to you a story so here's why we need evidence-based health care this is a king charles ii i'm not going to account to you the final days of king charles ii here's his resting state right here and we think he died of malaria but we're not really sure and at the time his chief physician kept a diary of what went on so this is well recorded we know what happened to this fellow so this was the beginning of the end for Port Charles on the morning of February the second 1685 king charles ii of england was preparing to shave when he suddenly cried out in pain and fell to the floor and started having fits when that happens what should you do what's that what do you think would happen well six Royal physicians rushed in and administered emergency aid now these are the best guys right because you got all the money and you get the best guys they all came in rushing in and so what they did is on Monday and please notice that that's very impressive I hope you're impressed with that they let drained or cut 16 ounces of blood they then applied heated cups to the skin which formed large round blisters in order to what they calls stimulate the system sure did and then they let out eight more ounces of blood and then they induced vomiting to purify his stomach gave him an enema to purify his bowels made him swallow a purgative to clean out his intestines because if the bad stuff wasn't in the blood where was it in your bow here right so you got to get rid of all that sort of stuff mmm so that kept they kept going they then force-fed him a serie for Blackthorne and rock salt they shaved his hair and put blistering plasters on his scalp and the King regained consciousness and as all good clinicians the treatments seem to be working so you kept at it one of the biggest problems we have no matter what you do your patients tend to get better and you go what I'm good and then they die and you go I was their fault so it was working so they gave him another enema they then applied an irritant powder up his nostrils and put more blistering plasters on his skin and powdered cowslip flowers to the stomach and then they got some special plastic made from pigeon droppings were attached to his feet and after 12 hours of care they put the alien king to bed on Tuesday he awoken seemed much improved in the attending physicians congratulated themselves and continued the treatment high-five yeah so they let 10 warehouses of blood by opening both jugulars they gave him a potion of black cherry peony lavendar crushed pearls and sugar soles place and he they said Charles slept for the rest of the day and throughout the night on Wednesday he awoke and had another fit and because it had worked before they bled him again they gave him senna pods in spring water and white wine with nutmeg nice touch then they force-fed him a drink made from 40 drops of extract of human skull of a man who had met a violent death because we do know any you privy we read New England Journal last time if it's not a violent death it just doesn't work and they made him eat a gallstone from an East Indian goat and then they proudly announced that King Charles was definitely on the road to recovery so when you have six Royal physicians telling you you are on the road to recovery what's likely happening yeah you're not doing well yeah so on Thursday the king was near death he was blistered again we bled reversion given in another enema he was given jesuits powder which was a controversial malaria remedy which had Quintin in it and was also laced with opium um wine finally something that I would want when I'm dying which is opium and is Allah this his doctors were mystified by the Kings weakening condition he has no blood [Laughter] so on Friday dr. Scarborough wrote and I don't know I might be saying all your charts are electronic so but you see what he wrote I mean I don't know if you start off your charts when you have to write a note I would started off like this it's nice because a nice touch alas I just you know give it it comes from the heart and he said after an ill-fated night his serene Majesty strength seemed exhausted to such a degree the whole assembly of physicians lost all health and became despondent and King Charles wasn't doing well either so on Friday showing no improvement the king was bled almost bloodless they scoured the palace grounds and created last-ditch antidote containing extracts of all the herbs and animals of Kingdom and poured ammonia down his throat and then they ordered plavix and norvasc stat oh no that's what you guys do yeah and on Saturday the King was dead so we tried to present that in a sort of a humorous fashion I'm trying to figure out the do between that and torture but back then that's what that's what the treatment was and and I don't know what's gonna be happening in 300 years but I would imagine there'll be some mind-meld thing that we'll all be doing but we'll still be laughing you're going you know what they did then they lowered cholesterol and they'll be laughing in your faces because they it was such a funny thing to do so you got to realise a lot of what you're doing people are gonna think is very very weird and funny and torturous we're getting better and we want you to encourage you to use evidence but realize that it's not all everything that you you know it seems to be

9 comments

  1. The lowering cholesterol thing is already losing favour. Maybe in a couple of years, we'll stop doing it.

  2. Evidence based medicine is broken and in crisis.
    http://www.bmj.com/content/348/bmj.g3725/rr/759895
    http://www.bmj.com/node/759181

  3. I actually adore Charles II (he was a good person and dangerously seductive) and this video made me cry! I know he said he was trying to make it funny but… I don't know it's just horrible 🙁

  4. What he is saying is that evidence based practice continues to change. These doctors were doing what the best evidence at the time was suggesting; however, it is clear today that they made several crucial mistakes. He is suggesting to continue to reflect, question, and critique your clinical practice, because the best evidence suggests that what we consider best practice today will probably be laughed at in the future.

  5. pretty obvious isn't it? without evidence all you've got is ignorance and received wisdom, and if you do more harm than good, you don't even know it. But the last few seconds are also interesting – what you think is OK now might still turn out to be nonsense – so stay alert! Wish I'd had someone like this when I was at uni

  6. can someone explain the video to me? are they trying to say that upon every administration, you should look at the evidence after then re-plan?

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