The following comment was written by Duke Powell in response to Where is the Evidence for Traction Splints?
I’ve been an urban paramedic for 34 years and, prior to that, a volunteer EMT for 9 years. For those who can’t add, ….that’s a long time.
How many times have I used a traction splint? …… I dunno, let’s guess 10 times.
That works out to an average of over four years between uses of the traction splint. That is plenty of time to have the memory of each use reconstructed many times, so that the memory and the reality may not have much in common. Each time we remember something, we recreate and modify the memory.
Several years ago, after several years of not even thinking about traction splinting, I found myself using it 3 times in 2 weeks.
Did it help? Yep, clinically, in my opinion, it helped.
Maybe it helped the patients. Maybe it harmed the patients. Maybe it helped some patients and harmed other patients. Maybe it helped the pain, but caused longer term harm. We do not know.
Without valid evidence, especially evidence of something more than the superficial appearance of improvement, we have no idea. We can use our imaginations and generate opinions, but we are merely discussing opinions.
Will Rogue Medic call my experience “anecdotal” and not worthy of consideration? Yes, he will.
Don’t care what the Rogue Medic thinks.
I care about what my patients and my Medical Director thinks.
Does calling an anecdote by a different name make it not an anecdote? It does not matter what you call it. A story is an anecdote. More than one story is just more than one anecdote.
What kind of follow up was there on the patients? What kind of comparison of the other variables was there?
Blood-letting looks like an excellent treatment – if we stick to anecdotes about blood-letting.
Physicians observed of old, and continued to observe for many centuries, the following facts concerning blood-letting.
1. It gave relief to pain. . . . .
2. It diminished swelling. . . . .
3. It diminished local redness or congestion. . . . .
4. For a short time after bleeding, either local or general, abnormal heat was sensibly diminished.
5. After bleeding, spasms ceased, . . . .
6. If the blood could be made to run, patients were roused up suddenly from the apparent death of coma. (This was puzzling to those who regarded spasm and paralysis as opposite states; but it showed the catholic applicability of the remedy.)
7. Natural (wrongly termed ” accidental”) hacmorrhages were observed sometimes to end disease. . . . .
8. . . . venesection would cause hamorrhages to cease.
How many patients did we kill with blood-letting? Thousands? Tens of thousands? Hundreds of thousands?
The opinions of medical directors have been in favor of many harmful treatments. Do you remember nifedipine?
Anecdotes do not become evidence of good patient care by telling the stories with style. Reality does not work that way, no matter how much we want to change reality. EMS shows us people who are having reality ignore their opinions about how the world should work. If reality is not going to change for a parent who wants their dead child back, how little is reality going to change for a paramedic who wants to put a positive spin on a treatment that he likes?
Reality does not care about our opinions.
Reality does not even care about the opinions of medical directors.
Science is the way we learn the difference between what is real and what is just a pleasing mirage.
What do you think science is? There is nothing magical about science. It is simply a systematic way for carefully and thoroughly observing nature and using consistent logic to evaluate results. So which part of that exactly do you disagree with? Do you disagree with being thorough? Using careful observation? Being systematic? Or using consistent logic? – Dr. Steven Novella.
Anecdotes are not thorough observations. Anecdotes do not use consistent logic. Anecdotes do not have anything to do with systematic evaluation.