When I was a resident, one of my mentors recommended that I buy this new handbook on evidence-based medicine by David Sackett. In the last decade or so, I've purchased maybe ten copies of this book. None remain in my possession. I keep loaning them out and no one ever returns them.
I remember the first time I read it, which isn't long. It was as if someone was pulling back the curtain, explaining to me how the practive of medicine would be if everyone was logical. When do you order a test? How do you interpret? How do you make decisions? What do all those numbers in the literature actually mean?
The book came with laminated cards that summarized the chapters. I used to carry them around the hospital with me, pulling them out whenever I thought a decision we were making wasn't evidence-based. I don't think that made me very popular with all of my attending physicians, but I know it made me a better doctor.
David Sackett is the father of evidence-based medicine. His texts are widely regarded as the first and last word on the subject, and his many manuscripts on the topic are as relevant today as they were when he wrote them.
It saddened me this week to learn that he had died. Not because he hadn't led a good and full life. An obituary at the BMJ this week lays out in detail many amazing facts about him that I didn't know. For instance, twenty years after completing his training, he repeated his residency in medicine because he felt that he "wasn't a good enough doctor". I can honestly say that there's not enough money in the world to get me to do that. He must have been an amazingly humble man.
Many things I did know, however. With Drummond Rennie, he published the Users' Guides to the Medical Literature, still THE reference book on the subject. He wrote a book on Clinical Epidemiology in the 80's, which is still "the bible of evidence based medicine." He was the founding editor of Evidence Based Medicine and the first chair of the Cochrane Collaboration. I knew he had "retired" even before that EBM handbook found its way into my library. But as with many amazingly productive researchers, retirement was a relative thing for him. After quitting clinical practice, he set up a research and education center in Canada where he continued to teach, research, and write about randomized clinical trials. Just a few years ago, he published a three part series on how to say "no" in order to succeed professionally. Any of my mentees would recognize much of what he wrote, because I've been living it and preaching it ever since.
As I wrote this piece, I realized that - once again - I seem to be without a copy of his EBM handbook. I went to Amazon to get a new copy, and discovered that just recently, he had published a book on evidence based mentorship in academic medicine. I immediately ordered one. It seems that even now, I still have much to learn from Dr. Sackett.
I also learned that his EBM handbook now seems to be out of print. I spent a little extra to get myself a copy from a third-hand seller. I won't be lending this one out.