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October 2013 XT GENERATION A DGH SCANMATES GH ATES THE NEXT GENERATION OF DG SCANMAT Portable USB A, B, and A/B Scans Ê Ê Ê Ê Ê Ê Ê A Portable USB A-Scan UC at Visit Us 131 h ooth #4 AAO B U U U U U Ê Ê A Portable USB B-Scan s s Tort continued from page 21 the first two of his meta-analytic studies, in 2001 and 2006, respectively, he found that the relative risks for clinical benefit were not enough to recommend the treatment. Instead, the best evidence in 2001 and 2006 suggested that conjunctivitis is a self-limiting problem and that patients would do just as well without an antibiotic. Dr. Hurwitz then proceeded to grit his teeth and do the ultimately rational thing: He started withholding antibiotic eye drops from patients with infective conjunctivitis. Remarkably, the next four patients he saw with conjunctivitis and from whom he had withheld an antibiotic seemed to suffer worse pain and discomfort for a longer period than those for whom he'd previously and routinely prescribed an antibiotic. Needless to say, Dr. Hurwitz was acutely conflicted between the evidence-based practice recommendation that he himself authored and his actual experience with real-life patients. His solution? "I quietly returned to prescribing antibiotic eye drops for patients with this condition." (I love the "quietly.") Later, in 2012, Dr. Hurwitz would produce a third meta-analysis, this one indeed showing a net benefit from using antibiotics. While Dr. Hurwitz is relieved by this, he doesn't think that the controversy over treating infective conjunctivitis with antibiotic eye drops is settled, and he called the most recent evidence "provisional." And that, I believe, is the fundamental problem with evidence-based practice. Even our "best" evidence at any particular time might be wrong, or it might roundly contradict a physician's personal practice experience—thus creating significant consternation should he or she choose to deviate from an evidence-based practice recommendation. So, although I thoroughly admire the idea of immunizing physicians from lawsuits when they comply with evidence-based practices, I am left with the suspicion that much of the science that underpins evidence-based practice does not meet the bar that the law would require for creating a "safe harbor." That's an important point: The kind of evidence that informs everyday clinical practice standards might not suffice as a sturdy defense in malpractice court. Clinical versus legal evidence are vastly different, such that tort reform measures hinging on evidence-based standards should proceed carefully. EW References 1. Mehlman, M. Medical Practice Guidelines as Malpractice Safe Harbors: Illusion or Deceit? Journal of Law, Medicine & Ethics. Summer 2012: 286-300. 2. Hurwitz, B. Confessional Ruminations on an Ocular Cure Testimonial. Atrium. Winter 2013: 12-15. Dr. Banja is a medical ethicist at Emory University, Atlanta, and the public member of the ASCRS Governing Board. He also consults frequently on medical malpractices cases. Readers are invited to send comments or case examples to him at jbanja@emory.edu. s s New Orleans fun facts s s s Purchase Scanmate A and Scanmate B Separately or at chase S Special A/B Scan Combination Pricing Serving Eye Care Professionals since 1982 nää®Ê ÇÓÓÎnnÎÊUÊ ÜÜÜ°`}°V The first Mardi Gras celebrated in the United States took place in 1703 in Mobile, Alabama—not New Orleans. Hear a reference to Satchmo? That's Louis Armstrong, famous New Orleans jazz trumpeter.