title: [Walking among doctors and patients. Stories and reflections.]
abstract: The clinician - the doctor who treats sick people - should be able to establish a good human relationship with his or her patients and their family; should be able to reach a diagnosis even in patients with rare diseases, or atypical presentations - or should refer the patient to a senior colleague; and should be able to recommend the best treatment (or no treatment at all). And he - or she - should be able to draw these abilities from the "deliberate practice" according to Ericsson, i.e. from the combination of experience with reflection - not, or with much lesser strength, from the medical literature as suggested by Evidence-Based Medicine. The diagnosis is often an easy task, i.e. by pattern recognition or recognizing a frequent illness script - "fast thinking" in the vocabulary of Kahneman; or a difficult task, sometimes very difficult for rare diseases or atypical presentations - "slow thinking" of Kahneman. The decisions about the use of therapeutic interventions, whether for individuals or entire healthcare systems, should be based on the totality of the available evidence. The idea that evidence can be reliably or usefully placed in "hierarchies" is illusory, and the pedestal deserved to the RCT is inappropriate.
authors.affiliation: Professore emerito di Medicina Interna, Università di Palermo.
authors.forename: Luigi
authors.initials: L
authors.lastname: Pagliaro
authors.affiliation: Direttore del Dipartimento Area Medica Ospedale A, Manzoni ASST Lecco.
authors.forename: Agostino
authors.initials: A
authors.lastname: Colli
mesh_terms: D003695:Delivery of Health Care; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D010820:Physicians; D016138:Walking