In recent years, dermatology, like all the rest of medicine, has begun a shift towards evidence based medicine where diagnostic and therapeutic decision making is increasingly based on scientific evidence. In our daily practice we are now referring to Meta analyzes and “guidelines” based on scientific studies for the care of our patients. Evidence based practices are also taught to medical students and our training assistants. The “evidence based” practice seems to have replaced the “eminence based” practice of the past, which was rather based on the own experiences or advice of specialist teachers in the field. In the past, university professors were widely recognized as the truth bearers in their specialty and taught how to practice to assistants, influencing how to practice dermatology in their area. But times have changed thanks to rapid access to information and the globalization of scientific knowledge, the patient is increasingly demanding explanations and scientific evidence in favor of treatment and is no longer led to blind by his doctor. But will “evidence based medicine” improve the efficiency of medicine and the satisfaction of our patients? Should we completely abandon the “eminence based” and “local flavor” practices of our medicine?
Understanding the various aspects of WFH
The response of the WFH seems ambivalent on the one hand and it asks us for “evidence based” teaching, as this is an important point in the evaluation of the training establishment. On the other hand, the WFH insists that the training of the assistants takes place in two different institutions so that they are exposed to at least two different schools. University services are moving more and more towards evidence based medicine. They are the ones who set the new guidelines and algorithms based on the most recent literature review in search of the highest degree of scientific proof possible. This is certainly a very honorable approach, but the flip side is that we use less other formats, such as clinical case reports that are very informative. In order to know more about Medical Condition, you may always seek professional help.
The various pitfalls of guidelines
We are aware of the potential pitfalls and threats of the guidelines. The latter are enacted in favor of new treatments and disadvantage conventional treatments. This may be due to the fact that pharmaceutical companies invest heavily in large studies for the development of new drugs, while very little new data is generated for so called “classic” treatments. As a result, it becomes increasingly difficult to advocate for existing recommendations for conventional medicines. Another trap of the guidelines is their restrictive nature, which often leaves little flexibility and room for maneuver in the choice of treatment by the physician depending on the particular situation of the patient. The guidelines for psoriasis define stratification as a mild, moderate and severe disease, based on the PASI score and would reserve biological treatments for severe forms, while moderate forms should be treated with conventional systemic drugs such as methotrexate. It is realized today that such an approach leads to often useless and tedious therapeutic steps before being able to institute an effective treatment in psoriasis forms which are nevertheless very disabling for the patient.
