Thread : The value of 50K+ patient encounters is often marginalized by some academic elites. The voice of the community cardiologist should be a loud one on twitter, as we represent >80% of all cardiologists. 1
Perhaps we should have a C-index for how many patient encounters someone has had? Next to thier K index? Theory is one thing, application another. 2
A K index is in a way a double edged sword. True academic luminaries and trialists should have as @RayDalio writes a “Believability weighting” which is basically what the K-index is. 3
However the use of the so-called K index puts people debating important points at risk of falling prey to “Argument for Authority logical fallacy”. 4
Esp when he references “the peanut gallery”, I’ve seen some trailists marginalize important and fair criticism of the trial design by non-trialists dismissing them as peanut gallery. We cant have this. 5
I’ve been involved in trying to enroll patients in clinical trials for many years now and sometime find it remarkable how hard it is to enroll patients due to stringent inclusion and exclusion criteria. 6
The Generalizabilty and usefulness of a clinical trials is only as broad as how easy it is to enroll patients, given we are dealing with complex systems, the rest is inference. As we bow down to the Gods of EBM I realize how little data we actually have that is useful 7
I think is important when we use a K_index, does this person actually know what is like to implement their recommendations on the fron lines of clinical care 8 ?
Do they recognize the challenges of using Epic, the fact patients cant afford their medicines, or that many American patients really aren’t fans of high dose betablockers....and high dose antianginal meds does affect QOL- its not a joke.9
What I love about twitter is we can learn from one another the Clinician and the Academic. We can engage and educate patients, most importantly we can twitter also us to challenge the status quo- this is a good thing. Destroy dogma. Destroy echo chambers.10
Respect authority but Challenge it. Everyday. Challenge it. We shall love our critics for they tell us our faults. Ben Franklin 11
The point of this tweet storm is the K index hit a nerve for me- because volume of publication does not equate to good clinical care. However some clinical trials are sheer gold and some research’s change the face of Medicine- lets us lift them up 12
But the K index, to me smacks of elitism separating cardiologists , ones work if it is great should speak for its self and need little defending for the true and quality should be apparent to all, esp peers. 13
I guess in closing my thoughts are this- what are the thought leaders afraid of, another good idea? Or a better one? Fin.
Honestly after I read this I felt a “stay in your lane” moment that I found distasteful. Intended or unintended - I didn’t find it incredibly constructive or progressive...
