Right, but you only have aggregates here moving the needle. For instance, your experience is that intervention A leads to >90% mobility elbow post-surgery in 90% of patients and intervention B leads to 80% mobility in 90% of patients.
What epistemological techniques do you use to distinguish intervention A from intervention B and how do you distinguish your experience from the paper that shows the opposite result?
The number of variables are large: including, distressingly, your skill at technique A and technique B. Is the difference in the outcome merely your lack of skill in one? Is the difference merely the lack of skill of the guys observed by the paper?
My parents are also experienced surgeons and the normalizing method they use is to share their findings with fellow surgeons. Patients where they work are much more amenable to having photographs of their surgeries used as discussion material.
Medical science is a primitive science and it is practised with primitive statistics, so most evidence is just missing. Lots of surgical techniques are discussed based on too little evidence with massive true error bars.
What epistemological techniques do you use to distinguish intervention A from intervention B and how do you distinguish your experience from the paper that shows the opposite result?
The number of variables are large: including, distressingly, your skill at technique A and technique B. Is the difference in the outcome merely your lack of skill in one? Is the difference merely the lack of skill of the guys observed by the paper?
My parents are also experienced surgeons and the normalizing method they use is to share their findings with fellow surgeons. Patients where they work are much more amenable to having photographs of their surgeries used as discussion material.
Medical science is a primitive science and it is practised with primitive statistics, so most evidence is just missing. Lots of surgical techniques are discussed based on too little evidence with massive true error bars.