Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Tuesday, September 02, 2008

Guidelines Gone Wild

Hey! Everyone stop what you're doing right now and PAY ATTENTION!

This is "Important":
The American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAO-HNSF) will issue the first comprehensive clinical guidelines to help health care practitioners identify patients with cerumen (commonly referred to as earwax) impaction. The guidelines emphasize evidence-based management of cerumen impaction by clinicians, and inform patients of the purpose of ear wax in hearing health.
(Um, they're actually *not* the "first" such guidelines. I found some pretty comprehensive ones here, at a Guideline Clearinghouse, dated 2007.)

Dear dog in heaven! A group of specialists putting together guidelines (and presenting them at their annual meeting, no less) on the diagnosis and appropriate management of SOMETHING MY FAMILY PRACTICE ATTENDINGS TAUGHT ME THE FIRST WEEK OF RESIDENCY!!!

I suppose this means that the ENTs now officially know everything. If they're actually bothering to waste their time promulgating stuff every family doc, internist and pediatrician learned before they knew how to get to the call room, they must not have much else worthy of study.

What next? The American Gastroenterological Association writing guidelines telling us how to wipe our asses after taking a shit (complete with prospective, randomized, double-blinded studies on folding vs. bunching the TP)?

(Thanks to the AAFP ListServe, whose comment trail demonstrated far more and funnier sarcasm than I am at liberty to replicate here.)


At Tue Sep 02, 09:23:00 PM, Anonymous Anonymous said...

As my kids say, WTF?

At Tue Sep 02, 11:20:00 PM, Blogger Geohde said...

If it's not abuse of our commonsense with the liberal application of over-filtered and over-thought guidelines then it's proving that black is the new white with the liberal misuse of 'evidence' based medicine.

Just because it's double blinded and randomised does not protect a trial from the curse of garbage-in = garbage-out



At Wed Sep 03, 04:52:00 AM, Blogger Elaine said...

Umm, your guide to taking a shit was incomplete and potentially dangerous; you forgot about washing the hands afterwards. ;-)

At Wed Sep 03, 07:24:00 AM, Anonymous Anonymous said...

I'll second Elaine -- and add that with some people, you should also mention the whole, "Open the lid to the potty and pull down your pants before you dump."

Always cater to the LCD.

At Wed Sep 03, 08:07:00 AM, Blogger Jon said...

Gee, I'd better read that. Maybe I've been doing it wrong all these years. No wonder I'm deaf...

At Wed Sep 03, 05:58:00 PM, Blogger Midwife with a Knife said...

I wonder how much time and effort went into those cerumen guidelines.

By the way, bunchers are terribly misguided. The most complete evidence suggests that folding is THE only safe way to wipe your ass. ;)

At Wed Sep 03, 10:58:00 PM, Anonymous Anonymous said...

Thank you for the worthwhile suggestion for future publications in gastroenterology. As a young attending, I need all the help I can get.


At Thu Sep 04, 03:10:00 AM, Anonymous Anonymous said...

What to do with the infamous "no wipers'?" I enjoy these almost as much as Drackman.

Just to be a rebel I am going to remove all wax that gets in the way of my TM peeping tom show.

At Thu Sep 04, 07:25:00 AM, Blogger Sara said...

I think someone got called to the ER in the middle of the night for a consult to remove earwax one too many times and just plain snapped.

At Thu Sep 04, 09:45:00 AM, Blogger Mike Craycraft said...

I am still confused if I wipe back to front or front to back. Plus, do you reach between your legs or around the back. I hope they let us know soon.

Perhaps these wonderful guidelines are just an easy way for self-promotion?

At Mon Sep 08, 04:10:00 PM, Anonymous Anonymous said...

Are the wiping guidelines culturally sensitive? How about cultures where alternative fibers are used rather than the corpses of trees? Are non-personal sources of chaa covered, such as that which rolls downhill?

At Wed Sep 10, 02:12:00 PM, Blogger Rogue Medic said...

We will have a guideline on "How to Give a S*#%."

I smell medical progress. Maybe even a journal article. The Onion, perhaps.

I think Midwife with a Knife is making an excellent start. I try not to argue with knife wielding people, although I am not following a formal guideline. Just a rule of thumb - how low brow of me.


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