Pruritus, PCAs and pain after Caesarean section

A recent editorial in Anaesthesia (Anaesthesia 1992; 47: 459-60) regarding persuasions in clinical practice was read with great interest. May one add the following thoughts to the wisdom in that editorial? The essentials of primary school education are based on the teaching of the three elementary ‘Rs’: ‘reading, ‘riting and ‘rithmetic.’ Persuasions in clinical practice should, similarly, be based on three, albeit more sophisticated, ‘Rs:’ records, results and references. The value of the latter three ‘Rs’ has variously been acknowledged by academics through the ages. M de Montaigne (1533-1592, philosopher) is quoted in each edition of the British Journal of Anaesthesia as proclaiming ‘I would have everie man write what he knowes, and no more.’ Lord Kelvin (1804-1907 physicist and engineer) wrote ‘If you record your observations and express your opinion in numbers you know something of the subject about which you are talking.’ M.F.M. James, Professor of Anaesthesia, University of Cape Town, challenges present day anaesthetists in training with the question, ‘What is your reference for saying that?’ Modern evangelists parry selfproclaimed ‘intuitive beliefs’ with the rejoinder, ‘One may be sincere, but one may be sincerely wrong.’ Furthermore, intuitive beliefs are subject to bias. This is well known to those Lngaged in research, where bias, unintentional but often unavoidable, is often confounded by the results of the research. Hence the requirement by the editors of journals for controls and blindness in clinical studies. The aforementioned exhortations and philosophies suggest that an alteration, with respect, of Montaignes quotation to read, ‘I would have everie man record and research what he does, and know more’ should rationalise the formulation of persuasion in clinical practice.