Its not an uncommon scenario for a medical under or post graduate to be refuted nonchalantly by his or her professor during the rounds in the ward despite quoting the management protocol of a disease from some text books/ journal/ article- only to  feel like a monkey when whole of the remaining lot- from intern to the patient itself, scan you with that mischeiveous smile…thinking… thoda pad le, bhai!

Later on, you may be found in the college cafetaria shouting, screaming and howling…..”How dare he”..or….”its just he/she has a personal vendetta against me”…or…”he hates me because he saw me wearing  a tight black tee with a graffitti….LOVE..LOVE..LOVE …the other day” or probably “he is plain jealous of me coz I am dating this college hottie” or coz “I am black”…blah..blah!!”

Is it? Well..I dont think so! why??

Because medicine is a gray area and more than one answer may be right depending upon patient and hospital factors except for anatomical/ pathophysiogical factual stuff. The management of disease is often a  dynamic thing…constantly upgrading itself from time to time….from large abdominal incisions to laparoscopy to telemedicine and robotics. Now I am hearing ever increasing  role of genetic manipulations, organ harvesting in lab and nanorobotics.

But more treatment modalities are creating more confusions and more controversies with protagonist from each modality shouting on top of there voices that there way is the right way!!

So how to avoid this confusion in you mind! The answer is not that difficult…All you have to do is to ask the level of evidence  before accepting it as an answer- grade the journal as per the table below using Jaded score(more about it later)

Therapy/Prevention/Etiology/Harm:

1a: Systematic reviews (with homogeneity) of randomized controlled trials
1b: Individual randomized controlled trials (with narrow confidence interval)
1c: All or none randomized controlled trials
2a: Systematic reviews (with homogeneity) of cohort studies
2b: Individual cohort study or low quality randomized controlled trials (e.g. <80% follow-up)
2c: “Outcomes” Research; ecological studies
3a: Systematic review (with homogeneity) of case-control studies
3b: Individual case-control study
4: Case-series (and poor quality cohort and case-control studies)
5: Expert opinion without explicit critical appraisal, or based on physiology, bench research or “first principles”

And the recommendations are- a02tab01

Grade A – Must do ie Gold Standard treatment

Grade B  – Should do ie generally acceptable traetment

Grade C-  Can do ie evidence is in your favour

Grade D- CAN NOT BE RECOMMENDED, Suggest options!! And if some wise guys quotes something from his personal experience remember its Just a Level 5(Grade D) recommendations. :))

So, Are you ready to argue with them-viva-2???????

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