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Dear Joe,
I agree with all you have said and would like to add two other aspects for readers to consider.
The first is the ability of a clinician to bring experience to the situation and to be able to incorporate that experience with both individiual clinical findings, as well as general research findings. Research needs to have many exclusion criteria to be "pure" and to eliminate as many confounding variables as possible, so this often means that research does not always represent the "real life patient" who sits infont of the oncologist. Also the clinician gets "the feel" for a treatment (e.g. the potential for side effects with particular groups) well before research findings are known, and these factors will undoubtedly influence clinical decision making, based on a judgement of the balance between least harm for best possible outcome. (Also unfortunately not all reasearch is good and statistics are only as good as those who are interpreting them.)
The second aspect to consider is the clinician's objectivity and ability to make decisions dispassionately, free of the hindrances of our personal desires, wishful fantasies, fears, defences, denials, rationalisation, etc, and based on the best evidence for the best outcome. That is why doctors make dreadful patients (unless they willingly hand over authority to another to be involved in a mutual decision making process) as they cannot make sensible rational objective decisions about themselves. And this is why doctors should never treat themselves or their family or friends, as their decisions about self or their loved ones will be muddied by subjective concern, rather than an objective concern and dispassionate acceptance of clinical findings.
Education is great and knowledge is power, but we also need to be scrupulously honest about our own internal processes that colour our judegments and decisions.
I look forward to further discussion and the outcomes of the Cochrane review in April.
Regards,
Vicki
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