New NEJM Interactive Feature: “Clinical Decisions”

From The Boston Globe:

For the first time, physicians will be asked to weigh in on what they would do for a patient, based on research papers published in the current issue and what they read about a fictitious case. Their choices will be tallied online for four weeks and their comments posted in an experiment to better connect with readers, editor-in-chief Dr. Jeffrey M. Drazen (left) said in an interview.


First up in the Journal is the case of a 30-year-old woman with mild persistent asthma who wonders if she should change her medications. The vignette is followed by three choices and an essay to support each option. Readers can make their picks and explain why online.

Okay, that sounds like a good idea…subscribers feel engaged and let the NEJM (and their colleagues) know what they think. It results in a feature that is generated by user feedback. That’s fine, I guess- but is it really any different from when CNN or Fox News set a question and invite viewers to call in with their opinions?

This part in particular threw me:

“Evidence-based medicine is somewhat of an illusory thing,” he said. “Very few patients fit the inclusion criteria for a clinical trial. It’s like putting together a jigsaw puzzle when the pieces don’t quite fit.”

Poll results from clinicians may add another piece of information about how clinical decisions are made.

“We hope to learn from them as well as having them learn from us,” Drazen said.

Does this confuse anyone else? How would a non-scientific poll of self-selected participants aid EBP efforts?

It is entirely possible (read: likely) that I’m just missing something here, so please do feel free to leave a comment and school me.

[via Kevin, M.D.]

7 thoughts on “New NEJM Interactive Feature: “Clinical Decisions”

  1. Weren’t you complaining just last month about being misquoted by the Cleveland Plain-Dealer? Parsing out a quote from a Boston Globe blog may be pushing this farther than is practical.

    It sounds to me like NEJM is trying to engage readers in a way that draws them into the content, which can’t be a bad thing.

  2. Hi William-

    First, I haven’t misquoted anyone- so I’m not sure from whence you draw the comparison.

    Second, I’ve explicitly said that this confuses me. I’m not criticizing (yet). I’ve clearly expressed a hope that someone might help alleviate my confusion.

    Third, I have explicitly stated that I think it is a fine thing for NEJM to want to engage readers. In this we appear to agree.

    Hey, it might be a poor piece of writing by the author of the article that places a Drazen’s quote in an inappropriate context- I don’t know. I am curious to know, however, if this struck anyone else as strangely as it did me.

    I’m far from expert on EBM/EBP. I’m looking to learn something.

    Thanks for leaving a comment!


  3. The response mechanism does ask you to identify whether you are Medic, Health prof, student or other. I would suggest that you would get a more select audience here than on the “What do you think?” segment of the BBC website for example.

    Most content on NEJM is also behind a login and this feature may go that way after a few freebies. This would cut down even further the random types (and unfortunately reduce the accessibility for many who have access to NEJM from another source).

    I think the EBM bit is trying to highlight the uncertainty in medicine.

    By asking people for comments and votes against a scenario people can consider how they came to a decision within this uncertainty compared to how others came to a different one.

    So the gain is not in terms of evidence around the best treatment but evidence around the clinical decision making process.

  4. Thanks, Alan!

    “By asking people for comments and votes against a scenario people can consider how they came to a decision within this uncertainty compared to how others came to a different one.”

    That makes plenty of sense to me. What about the aggregate information presented by NEJM when all respones are tallied? What will be learned from that?

  5. David–

    Sorry if you thought I was saying you misqouted anyone. What I meant was, it is entirely possible that the Globe in its blog didn’t get things exactly right. When something in a piece like this in a blog or newspaper seems fuzzy it is usually the writer who is unclear and not the subject being quoted.

    On the evidence issue, the evidence is not always clear cut for clinicians, and it seems like that is why NEJM is trying to engage readers in weighing evidence in decision making. It will be interesting to watch how the voting and comments build over the next couple weeks.

  6. I think we agree, William, that my confusion is more caused by the writing than by the person being quoted.

    I absolutely agree that it will be interesting to see the results of this experiment in user participation. 🙂

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