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Old 17th July 2018, 07:41 PM   #351
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Join Date: Nov 2010
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Originally Posted by Skeptic Ginger View Post
IMO, if you're interested and suspect you aren't, you're confusing where one applies evidence based medicine and where one applies experience and education.
I am very interested in the practice of medicine because such knowledge enhances my ability to manage a medical practice. Medical pactitioners gain knowledge and experience in applying science to diagnosing and treating problems with the body. Everything they do is rooted in science. Methods that donít stand up to scientific scrutiny are rejected. Do you think thatís fair to say?

Evidence based medicine was applied to developing the DSM(hopefully), both diagnosis and treatment recommendations. It includes tests one would do to rule something in or out.
So far so good. I agree with this.

Education and experience are how one gains the skills to recognize a diagnosis or the differential and decide what to do after that.
Here is where our disconnect is and letís see if we can resolve it. I would say that the very methods used to come up with a diagnosis or differential are also based in science. The experience and skill is developed to learn which methods are appropriate for each presentation. Can you think of one area in your professional practice where you donít use diagnostic methods with a basis in science? I would wager that everything you do is supported by science and that as new research comes in and guidelines change, so does your practice.

You are dogmatically applying the in-person rule.
Absolutely not. 1)The APA, the same organization that (we both hope) used EBM to develop the DSM, also used the latest evidence to initially develop and now reassert its support for the in-person exam. 2)There is no other method with support in the science -as imperfect as it may be, itís all there is.
You cannot say what one would gain in this case, because there isn't anything),
I have given several things to be gained -objectivity, the fiduciary duty, etc- but you are essentially right: it isnít for me to present that. The APA has done that already.
we've cited some professional opinions pointing out that said in-person exam was not always required, and this was just the kind of case where the in-person exam would add nothing.
And you know what? They may be right! Their task, then, is to gain support for these ideas by putting in the work and developing an evaluation method that is objectively better. Until then, itís just an opinion, not a new method of psychiatric evaluation.

Common sense tells you that Trump would lie if you examined him in person, and that one wouldn't gain any additional insight.
I donít believe in common sense. You could make that argument about any narcissist. I am confident that skilled and experienced professionals engaged in an ongoing therapeutic relationship could use the latest methods and tools to arrive at an accurate diagnosis -even with a deceptive subject.

A person who doesn't have experience in diagnosing a patient might erroneously try to apply some evidence based medicine principle or process when that is not where, why and how you apply it.
The problem is that there is no other method to apply. At least no method that has support in science.
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