EVIDENCE-BASED DECISION MAKING

The art of medicine consists in amusing the patient while nature cures the disease.

Patient in ECMO

Image via Wikipedia

Voltaire

Much has been said about making decisions and pursuing actions based on sound evidence.  In medicine, doctors are urged to use the best available evidence and not to rely on hearsay or unsubstantiated claims.  Today, with all the technology and equipment available, it has become faster and easier to collate data and execute decisions based on the data gathered.

Evidence-based medicine is a decision-making model that supposedly enables us to make critical decisions. It requires meticulous data gathering and research before making healthcare decisions. Such decisions include clinical decisions about choice of diagnostic tests, treatment, or risk management for individual patients, as well as policy decisions for groups and populations.

However, evidence-based medicine has its limitations.  It may be able to answer queries on probabilities of benefit or harm, but it cannot completely explain details on mechanisms or people’s feelings.   Thus, evidence-based medicine is helpful for deciding whether to carry out certain procedures, but it is not very helpful for finding out how a patient feels today, or why a particular atom or behaves the way it does inside the human body.

Many patients have multiple diagnoses and problems. Diagnosis alone is a poor predictor of treatment outcome. Personality characteristics and social circumstances influence therapeutic response.  While evidence is important, we must remember  that we treat human beings with emotions, fears, and anxieties.  There are also other factors to consider such as finances and social support systems.  All these come into play when making treatment plans, and clinical experience plays a big role in holistic healing. If medical management were solely based on statistically measurable standards of evidence, then our training programs will no longer need experienced physicians.  Just give every student access to the Cochrane library and they will be able to treat a disease.

The personal qualities of the physician have an important bearing on patient satisfaction.  Sophisticated clinical expertise with regard to an individual patient needs to be balanced with evidence. It is my belief that too much emphasis on a narrow range of acceptable evidence oversimplifies the complex nature of clinical care.  Medical care must not come to a point where a patient would rather log on to a computer and follow the process flow.  After all, medicine was, is, and will always be a relationship business.

 

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2 comments on “EVIDENCE-BASED DECISION MAKING

  1. Enjoyed your article. I have been an x-ray tech for 30 years, and agree that evidence-based care is an important part of treating patients, but it doesn’t give the whole story. Patients are not a collection of lab values and radiologists’ reports.
    Thanks also for you kind acknowledgement of my blog post, “Good Advice from the Grinch.” Merry Christmas!

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