The Trials and Tribulations of Evidence Based Medicine
Many healthcare professionals feel that we have been brainwashed into an 'evidence based medicine' approach to healthcare, I feel it is important that we understand the problems with an evidence based approach to healthcare.
All health care systems have to be cost effective and therefore make financial decisions to balance the books - but let us understand that this is the driving force for evidenced based medicine.
There are gains by understanding evidenced based medicine: we are able to evaluate risks as well as positive outcomes.
A rare risk, which is life threatening, would not usually be tolerated for an illness such as a cold, so I am not declaring the end of evidence based medicine but merely suggesting that it should not be the only way to make decisions about how we treat our patients.
In an era of 'patient choice', the public should realise that they have less choice than ever before, now with protocols, guidelines and targets, many of which have financial incentives attached - choice is no longer an option.
Medicine, should be about the uniqueness of our patients and I should be able to listen to their aspirations and fears, understand the symptoms and manage their condition - I want to embrace their choices and understand why.
Evidence based medicine is about averages, it makes assumptions that all treatments work equally in every-one.
This is not the case, one treatment may make a huge difference to one person and make no improvement to another.
If a treatment shows an enormous improvement but only in 5% of individuals, the evidence base will show this as ineffective - if you had a serious condition - would you want to try it, especially if the side effect profile of the treatment is low.
I appreciate that for many of the new treatments, these are expensive and maybe we can't afford to treat the masses in the hope that an odd person will benefit but let's not be dishonest.
Many treatment options that we may choose to implement are not high cost - using medicines that have been around for a long time, cheap and generic.
Surely, an understanding of the evidence base of medicine, combined with the art of managing individuals with conditions is the best way forward and if we can't afford the treatment - lets not pretend that it does not exist.
All health care systems have to be cost effective and therefore make financial decisions to balance the books - but let us understand that this is the driving force for evidenced based medicine.
There are gains by understanding evidenced based medicine: we are able to evaluate risks as well as positive outcomes.
A rare risk, which is life threatening, would not usually be tolerated for an illness such as a cold, so I am not declaring the end of evidence based medicine but merely suggesting that it should not be the only way to make decisions about how we treat our patients.
In an era of 'patient choice', the public should realise that they have less choice than ever before, now with protocols, guidelines and targets, many of which have financial incentives attached - choice is no longer an option.
Medicine, should be about the uniqueness of our patients and I should be able to listen to their aspirations and fears, understand the symptoms and manage their condition - I want to embrace their choices and understand why.
Evidence based medicine is about averages, it makes assumptions that all treatments work equally in every-one.
This is not the case, one treatment may make a huge difference to one person and make no improvement to another.
If a treatment shows an enormous improvement but only in 5% of individuals, the evidence base will show this as ineffective - if you had a serious condition - would you want to try it, especially if the side effect profile of the treatment is low.
I appreciate that for many of the new treatments, these are expensive and maybe we can't afford to treat the masses in the hope that an odd person will benefit but let's not be dishonest.
Many treatment options that we may choose to implement are not high cost - using medicines that have been around for a long time, cheap and generic.
Surely, an understanding of the evidence base of medicine, combined with the art of managing individuals with conditions is the best way forward and if we can't afford the treatment - lets not pretend that it does not exist.
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