Changing practice with evidence-based aphorisms.

102 British Journal of General Practice, February 2013 The Australian Family Physician (AFP ) is the journal of the RCGP’s Australian cousin, the Royal Australian College of General Practitioners — consider it Neighbours to the BJGP’s Eastenders. The AFP has started an interesting series of articles looking at the evidence behind some medical aphorisms. They have examined whether a careful history leads to the diagnosis 80% of the time (perhaps, but half the diagnosis was in the referral letter)1 and whether a doctor who treats him or herself has a fool for a patient (Yes).2 Wouldn’t it be interesting to know if there is anything behind all those other sentences we vaguely remember from medical school; if only to justify passing them on proudly to medical students ourselves. After all, they are often the only things we do remember from medical school. Doctors such as William Osler have been very productive in writing aphorisms that have stayed with us for nearly a century now. Entertaining though the AFP series is, I’m not sure I’ve found them useful yet. Is it a solution in search of a problem? If so, perhaps I’ve found the problem. There is a burgeoning field of implementation science because we’re gradually realising that just providing information in the form of journal articles, systematic reviews, and evidence-based guidelines doesn’t actually make us change very much. It can be quite entertaining to watch policy experts flap their hands telling us to just implement the evidence. While it’s a complex area, what marketers and religions have known for a long time is that information doesn’t change behaviour, stories do. Religions tell us stories that orient our lives. Not even marketers can tell you what the ‘Seven Signs of Aging’ are when they buy the skin cream: it’s the fresh colours and smiley people that bring you in. And then there’s a catchy slogan that they want you to remember, like ‘Seven signs of aging’. Which is where we get back to aphorisms. Would Cochrane Systematic Reviews be less boring to read if they started ‘Once upon a time, a group of patients had these strange symptoms, and their doctor just didn’t know what to do’? Better still, what if journal articles and guidelines had to invent an aphorism as part of their abstract? Would their findings be easier to implement if we had a pithy aphoristic summary? Obviously we need a trial, but we could start by writing and collecting aphorisms from the medical literature now: our own Book of Proverbs. Here are some to start with: