Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Monday, October 20, 2014

NY Times: Why Doctors Need Stories

I just want to link to an article by Peter Kramer, published today in the NY Times:

Why Doctors Need Stories

It's about the role of the case vignette, and how it shouldn't be discounted in the face of evidence based medicine. It also reflects my personal opinion about the significant limits of CBT, despite all its hype.

I submitted this comment:

As a psychiatrist and psychoanalyst, I applaud Dr. Kramer's embrace of "the story". But I don't think case vignettes need to be limited to the role of adjunct to evidence based medicine. Case vignettes actually do supply statistical evidence. A research group from the University of Ghent, in Belgium, specializes in Meta-Synthesis (as opposed to meta-analysis), in which they mine the data generated by a large collection of single case vignettes. You can check out their website: singlecasearchive.com, where you can search for different parameters within papers that have already been published.

You may recall my mention of this topic in a post from last January, The Rest of the Meeting. Feel free to recommend my comment (under the name, Physician NYC-not sure how that happened) from 2:14pm on Sunday the 19th.


  1. A-B-A.... Analysis of effects on a single subject dates back to the days of intensive behavior therapy.

    I also heard Ben Stein say: "At some point the anecdotal becomes the statistical."

    I put the following question to a meta-analysis guru:

    "At this point I have treated thousands of patients with a number of different conditions. In some cases I have treated more patients than I have seen in the meta-analysis. At what point does my experience become more relevant than the trials or meta-analyses with a much smaller N that I have personally treated?"

    That was about a year ago and I have not received an answer.

  2. I loved his essay and tried not to read too many of the comments since I hate seeing all the negative anti-psychiatry rants (a few admittedly deserved). All of medicine is about the story. If you listen to your pt and not focus on the computer you can hear it. The pt always tells us what we need to know (I am simplifying it) but it CAN take awhile. Not 15 minutes.