Why EBM won’t fly in the United States

There is an interesting discussion going on at Blogborygmi. Nick applied the evidence-based Ottawa ankle rules in a situation, only to be overruled by his attending – “in our country, I can’t afford not to get an X-ray.” Discussion ensued in the comments, with arguments discussing whether EBM is merely a cost-containment strategy versus good medicine.

I would agree with the attending in this case. Until physicians are sued for doing too much testing, I will always err on the side of extra testing. Cover-your-ass indeed. The reality is this – they always get you for the zebra you miss. We are in a nation where physicians are practicing two forms of medicine – “correct”, evidence-based medicine and United States-style, defensive medicine.

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  • kittykitty!

    Yeah, I trained at the University of Rochester, which is big in EBM. We were always looking at the evidence and the 2 x 2 tables and deciding how cost effective this or that was. . . then I went to practice on my own in the real world. I found myself doing the mammos on 40 year old women, even though the EVIDENCE said start screening at 50, because community standards were different where I lived and my threshold for getting sued and a fullblown panic attack was pretty low. . . It’s different in the WORLD.

  • Kevin

    Completely agree. There are two worlds out there: the “ideal”, evidence-based world and the “real world” (sounds like a scene from “The Matrix”). More on this from a previous post: http://www.kevinmd.com/blog/2004/06/ideal-medicine-vs-real-life-medicine.html

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