Bioethics Discussion Blog: “Grains of Truth” vs Evidence-Based Medicine”

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Saturday, December 09, 2006

“Grains of Truth” vs Evidence-Based Medicine”

For the layman, “old wifes’ tales” (“a wisdom much like an urban legend, supposedly passed down by old wives to a younger generation. It is so named for the alleged lack of sophistication of old wives.”) often deal with sex, pregnancy, puberty, nutrition and health issues. Most of the tales have no basis in fact but occasionally a few have, as quoted from the Wikipedia article, “... grains of truth, the veracity is likely coincidental.”

In medicine, physicians have carried along the professional version of “old wives’ tales” through the years, the veracity of which was mainly based on a physician’s own personal experiences in practice, the reports of other physicians experiences or just theories. Some of these tales dealt with issues of diagnosis or illness outcomes and others dealt with therapeutic benefit of drugs or procedures.

In the last decade or so, out of concern for providing the best in medical care but also because of concerns relating to the financing of medical care that the medical profession and others have looked to providing physicians and their patients the results of “evidence-based medicine” which defined by the Centre for Evidence Based Medicine as quoted in the Wikipedia article “is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients." And continuing from the Wikipedia article “Using techniques from science, engineering and statistics, such as meta-analysis of scientific literature, risk-benefit analysis, and randomized controlled trials, it aims for the ideal that healthcare professionals should make ‘conscientious, explicit, and judicious use of current best evidence’ in their everyday practice.”


What has all of this to do with medical ethics? It has to do with the physician’s duty to be trustworthy to the patient and to aim to do good and not produce harm to the patient. Informing the patient, unless some patient rejects being informed, is also duty of the physician and is part of the consent to treatment process. It should be a standard of medical practice that the patient understand what portions of the physician’s decisions regarding diagnosis, prognosis or treatment is based on reliable evidence and which is based on hearsay or simply statistically not verified experience. But do most physicians have the time or skill to explain to the patient on what basis their decisions were made? Further, do most physicians even know which of the “facts” they are using have not been rigorously proven? Unfortunately, even with the best of physician attention to educate themselves on the evidence and to explain this to the patients, there is much in medical care that will remain “old tales” either because there is not sufficient interest to provide the time and expense to do scientific studies or realistically because some studies just can’t be accomplished because of technical or ethical issues. Fortunately,for both the patient and the physician, many decisions the physician makes do have incidentally those “grains of truth” and are luckily followed by successful outcomes. ..Maurice.

4 Comments:

At Sunday, December 10, 2006 9:52:00 AM, Anonymous Hans G. Engel, M.D. said...

We physicians learn from the day you started to moment of read and heard knowledge. Most of the time we are convinced that we have learned the truth. However we always know that our absolute knowledge is certain, but have doubt at times.
We are more offered huge amounts of "facts" from sources, from questionable scientiets, healthproviders, quacks, tribal magicians - and "old wives".
Most of such information is usually useless, however we at times find that such trues turn out to be genuine and should our traces of doubt in our mind.

 
At Monday, December 11, 2006 10:39:00 AM, Anonymous Eric said...

I wish more physicians would read critically and examine the "evidence" put forward in articles and web pages. Taking a moment to answer the question of "where is this information coming from" is critical. Follow that "with is this data reliable enough to treat my patient with."

It is hard to change tradition when new healthcare providers come into the field with this attitude and then see how their seniors act, it is hard to stay with the critical reading point of view. Particularly when there is little time to research.

I would encourage any health care prover to take a few minutes with their medical librarians to see what services and tips they have to offer.

 
At Friday, January 12, 2007 9:55:00 PM, Blogger Maurice Bernstein, M.D. said...

Sometimes a doctor doesn't need any evidence to reach a conclusion:

Doctor: Have you had this before?

Patient: Yes

Doctor: Well, you’ve got it again.

..Maurice.

 
At Friday, January 12, 2007 10:22:00 PM, Blogger Maurice Bernstein, M.D. said...

I have revised Peter's posting to reformat the link. However the topic of the conference involves the developing healthcare concept of "convenient care", where non-physician staffed offices will be readily available around the community to provide medical care without appointments. The video discussion link goes well beyond simply questioning whether evidence based medicine will be practiced in these offices. The issue is whether this kind of practice will be both beneficial and safe for the public. I hope to start a new thread on the Convenient Care concept. ..Maurice.

At Thursday, January 11, 2007 10:29:38 AM, peter said...

This panel discussion (online video)between the AMA, AAFP and the ACNP touches on evidence based medicine.

 

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