Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
Eur J Intern Med. 2013 Apr;24(3):222-6. doi: 10.1016/j.ejim.2012.12.011. Epub 2013 Jan 9.
Despite the emergence of evidence-based medicine, gaps in medical knowledge are filled by tradition, common sense, and experience, giving rise to medical myths.
We explored the origins of and evidence related to four medical myths: patients with shellfish allergies should not receive intravenous contrast, patients with atrial fibrillation of less than 48 hours' duration do not require anticoagulation before cardioversion, patients with suspected meningitis should have a computed tomography (CT) scan before a lumbar puncture, and patients with respiratory disease should not receive β-blockers. We conducted a literature review to describe each myth's origins and the quality of supporting evidence.
All patients with allergies, including but not limited to seafood allergies, are at an increased risk for anaphylactoid reactions to radiocontrast. No conclusive studies indicate that patients with atrial fibrillation of less than 48 hours' duration do not require anticoagulation before cardioversion. A CT scan before lumbar puncture in suspected acute bacterial meningitis is a clinically inefficient precaution. β-blockers can be safely used in patients with respiratory disease and may even prevent cardiac events in these patients.
These familiar myths have maintained prominent roles in medical thinking because they represent wisdom passed down from eminent sources, they teach physiology and medical skills, and they offer physicians a sense of control in the face of uncertainty. In addition to providing scientific evidence, changing physicians' practice requires acknowledging that even meticulous care cannot always avert bad outcomes.
尽管循证医学已经出现，但医学知识的空白仍然依赖于传统、常识和经验来填补，从而产生了医学神话。
我们探讨了四个医学神话的起源和相关证据：对贝类过敏的患者不应接受静脉造影剂；持续时间少于 48 小时的心房颤动患者在电复律前不需要抗凝；疑似脑膜炎的患者在腰椎穿刺前应进行计算机断层扫描（CT）；患有呼吸道疾病的患者不应接受β受体阻滞剂。我们进行了文献回顾，以描述每个神话的起源和支持证据的质量。
所有过敏患者，包括但不限于海鲜过敏患者，都有发生造影剂过敏反应的风险增加。没有确凿的研究表明，持续时间少于 48 小时的心房颤动患者在电复律前不需要抗凝。在疑似急性细菌性脑膜炎的情况下，在腰椎穿刺前进行 CT 扫描是一种临床效率低下的预防措施。β受体阻滞剂可安全用于患有呼吸道疾病的患者，甚至可能预防这些患者的心脏事件。
这些熟悉的神话在医学思维中仍然占据着重要地位，因为它们代表了从杰出来源传承下来的智慧，它们教授生理学和医学技能，并为医生在面对不确定性时提供控制感。除了提供科学证据外，改变医生的实践还需要认识到，即使精心护理也不能总是避免不良后果。
