Exception, evidence, experience-based medicine: The evolution of medical practice and the Greek paradox

摘要

At the start of my career as a young Ob/Gyn consultant in a rural Greek hospital, I came across a bizarre, yet common phenomenon. A group of junior doctors and I were discussing the case of a woman about to be discharged, who had had a medical termination of pregnancy at the 17th gestational week due to fetal anomalies. The registrar who was to discharge the patient asked me, "Should we prescribe any medication in order to inhibit lactation?" Current practice guidelines and evidence from the literature suggest that such a treatment is not necessary and furthermore might be unsafe for the patient, so I advised my colleague was against the prescription of further medication. Two other junior doctors who were present during the conversation then referred to a similar case of a patient who had returned to the clinic a few days after her initial discharge with fever and breast tenderness. She had been also discharged without medication. All the registrars were familiar with this case. One of them concluded, "Perhaps we should prescribe some kind of drug anyway, in order to be on the safe side."