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David Sackett passed away recently. We don't usually do obituaries here, but this one seems appropriate. This is Healthcare Triage News.
This was adapted from a piece I wrote for the AcademyHealth blog.

All the references and links are there: http://blog.academyhealth.org/remembering-dr-david-sackett/

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David Sackett passed away recently. We don't usually do obituaries here, but this one seems appropriate.

This is Healthcare Triage News.

(Intro plays)

When I was a resident, one of my mentors recommended that I buy this new handbook on evidence-based medicine by David Sackett. In the last decade or so, I've purchased maybe ten copies of the book. And until yesterday, none of them remained in my possession. I kept loaning them out, and people would never return them.

I remember the first time I read it. It was as if someone had pulled back the curtain, explaining to me how the practice of medicine would be if everyone was logical. When do you order a test? How do you interpret it? How do you make decisions? What do all those numbers in the studies actually mean?

The book came with these laminated cards in the back that summarized the chapters. Here's the one on diagnosis, for instance. You'll recognize this little chart here from our episode on sensitivity and specificity. This book is where I learned all that stuff.

I used to carry the cards around the hospital with me, pulling them out whenever I thought a decision we were making wasn't evidence-based. I don't think that made me very popular with all of my attending physicians, but I know it made me a better doctor.

David Sackett was the father of evidence-based medicine. His texts are widely regarded as the first and last word on the subject, and his many manuscripts on the topic are as relevant today as they were when he wrote them.

It saddened me this week to learn that he had died, not because he hadn't lead a good and full life. An obituary at the BMJ this week (links down below) lays out in detail many amazing facts about him that I didn't know. For instance, twenty years after completing his training, he repeated his residency in medicine because he felt that he wasn't a good enough doctor. I can honestly say that there's not enough money in the world to get me to do that. He must have been an amazingly humble man.

Many things I did know, however. With Drummond Rennie, he published the Users' Guides to the Medical Literature, still the reference book on the subject. He wrote a book on clinical epidemiology in the '80s, which is still "the Bible of evidence based medicine." He was the founding editor of the journal Evidence Based Medicine and the first chair of the Cochrane Collaboration, which all of you should recognize from videos.

I knew he had retired even before that EBM handbook found its way into my library, but as with many amazingly productive researchers, retirement was a relative thing for him.

After quitting clinical practice he set up a research and education center in Canada where he continued to teach, research, and write about randomized clinical trials. Just a few years ago, he published a three part series on how to say "no" in order to succeed professionally.

Any of my mentees would recognize much of what he wrote because I've been living it and preaching it ever since. As I wrote this script I realized, once again, I seem to be without a copy of his evidence based medicine handbook. I went to Amazon to get a new copy and discovered just recently he'd published a new book on evidence based mentorship in academic medicine. I immediately ordered one. It seems that even now I still have much to learn from Doctor Sackett. I also learned that his evidence based medicine handbook now seems to be out of print. I spent a little extra to get myself a copy from a third-hand seller. I won't be lending this one out.

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