Notwithstanding the epistemological inconsistency inherent in discussions of “my evidence” vs “your evidence” (after all, if “evidence” is not about an objectively verifiable shared reality, then it’s not evidence”), I appreciate the call by Douglas Badenoch and André Tomlin to “dramatically improve the way important new evidence is communicated to the people who need it most.”
While they helpfully argue for finding ways to use the continually evolving tools of social media to communicate evidence, we need to think carefully not just about platforms, but also about content. Reading tweets and blogs and email updates is certainly a quick-and-easy way to access information, but for those on the writing and dissemination side of the equation, there needs to be careful thought given to how that information is translated from complex findings into accessible “e-bites.”
A while back I’d posted some thoughts (only partly tongue-in-cheek) on the value of “writing 55 word stories, haikus, sonnets, or even tweets, in order to sharpen our abilities at turning information we have received into meaningful, concise, and clear stories of what is happening with our patients.”
As much as brevity with clarity is important for relaying a patient story, it is also vital for conveying the complexity of medical evidence to our colleagues and our patients. Given the headline-based way we usually get both our general and medical news, it is easy for evidence communication to degenerate into “good vs bad” – drug “x” is good, drug “y” is bad, “always do this”, or “never do that.” While it is true there are some ideas in medicine that seem categorically applicable, in most cases nuance is needed.
We do have a few conceptual tools to help us.
- For many years, “PICO” has been considered a standard way to both assess medical literature, and conceptualize how to communicate it to patients. In communicating evidence, we need to communicate clearly WHO the relevant patients are, WHAT the intervention options are, and WHAT the relevant outcomes are.
- There has been increasing attention in publication of study findings, to presenting comparative results, or at least giving quantification not only of benefits, but also adverse effects. We need to continue the move toward presenting balanced reporting of BOTH desired AND undesired outcomes of interventions (rather than, “this worked, but oh, by the way, we also had a few problems.”) A good example of this was last year’s NEJM publication of “A Randomized, Controlled Trial of Total Knee Replacement.”
As Badenoch and Tomlin point out, social media (just like the printing press!) is here to stay. Unfortunately, so are misinformation, distortion, and biased representation of evidence and information.
For those who seek to translate medical evidence into clinically useful information, for both colleagues and patients, the ongoing challenge will be finding ways to clearly and concisely convey nuance and complexity, in formats that are brief, understandable, and (relatively) easy to remember.
Perhaps it is time to move from “PICO” (with all due respect to the acronym’s history, and to lovers of Mexican food) with “PB&J” (for this PATIENT, what are the BENEFITS of the action, and the JEOPARDIES)?
The fewer the words—the bigger the challenge!
William E Cayley Jr practices at the Augusta Family Medicine Clinic; teaches at the Eau Claire Family Medicine Residency; and is a professor at the University of Wisconsin, Department of Family Medicine.
Competing interests: I declare that I have read and understood BMJ policy on declaration of interests and I have no relevant interests to declare.