Opening Dialogue
Sherlock Holmes pays a visit to Dr. Watson’s practice
Holmes: Ah. A man of medicine in his natural habitat, a pleasing sight to
behold!
Watson: My dear Holmes. So good of you keep your promise. Surely you do
not mean to tell me that you already have answers for me?
H: A promise is a promise Watson, and this one I am delighted to
fulfill. It is the least I can do in return for your longstanding
devotion. Let’s begin. If I understand correctly your wish is to do your best
to prevent cardiovascular disease in your practice.
W: That is my main concern, Holmes. Cardiovascular disease (CVD for short) is
the leading cause of death in the western world and is rapidly becoming number
one in developing countries (3)(4)(5)
H: And by cardiovascular disease, you are referring mainly to Ischemic
Heart Disease, Cerebrovascular Disease and Peripheral Artery Disease?
W: Correct, Holmes. I see you have researched the subject.
H: Very well. Now, there are known risk factors for CVD and their modification
can reduce CVD to a considerable degree, thus lowering illness and mortality.
See Risk Factors.
W: Yes. These are termed cardiovascular risk factors and contribute both
singly and in concert to the evolution of CVD.
H: And as a modern physician,
you regularly keep abreast of new developments in the field of cardiovascular
risk factor modification.
W: I make an effort to stay informed. I rely on clinical-practice guidelines
from high quality sources. These guidelines are updated periodically and are
available on the Internet.
H: Excellent Watson. Now pray tell me, what is this here on your desk?
W: Come now, Holmes. You know a computer when you see one. You yourself never
leave home without your laptop any more.
H: I am aware of the contraption’s name, Watson. I was asking: what do you use
it for? What is a computer doing on a physician’s desk?
W: Well, Holmes, this computer houses the software on which I keep my
patients’ medical records. The Electronic Medical Record -EMR for short- has
replaced the traditional paper file. I made the change two years ago.
H: I see. And other than serving as a receptacle for storing information, did
you consider the EMR’s other capabilities?
W: I do not follow you, Holmes. The EMR is simply an electronic patient file,
is it not?
H: A misconception, my dear friend, which I will soon put right. But let us
recapitulate. If the problem is not a lack of knowledge, nor access to this
knowledge, then what is it?
W: Well, Holmes. Every now and then I come across a patient for which
more could have been done in terms of cardiovascular risk reduction, or could
have been done sooner. Ideally, cardiovascular risk factors should be detected
and treated as early as possible, but reality seems to fall short of this
ideal.
H: Aha! Then the problem is one of applying the knowledge to your patient
population.
W: Exactly. I feel as if a gap exists between what can be done and what
actually is being done. The medical literature supports this feeling of mine:
a gap indeed exists between clinical knowledge and clinical practice. (1) (2)
H: A gap in need of bridging.
W: That’s it, Holmes. A gap to bridge.
H: And bridge it we shall!
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Preparations
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