TIME.com looks at its limits:
Medicine, after all, is a personalized service, one built around the uniqueness of each patient and the skilled physician’s ability to design care accordingly. “I’m worried about training a generation of physicians who don’t have the other skills they need for the optimal practice of medicine,” says Dr. Mark Tonelli, a pulmonary-care specialist at the University of Washington in Seattle. “They can read the scientific literature, understand the statistics, but they don’t understand how that should influence their treatment of the individual in front of them.” What’s more, some insurance companies have been very aggressive in using evidence-based arguments to deny payment for untested treatments–a circular problem, because how do you create the evidence the insurers demand unless you test the untested?
And yes, the article invokes the Daniel Merenstein malpractice case, which dealt a severe blow to the practice of EBM.
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- Does evidence-based medicine raise costs?
- Marc Siegel apparently doesn’t care about evidence-based medicine
- Evidence-based medicine is hard to implement
- Why patients will reject evidence-based medicine
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{ 4 comments }
In other words, evidence based medicine has been the touchstone of medical education, academics, and payors for more than a decade. It is now about time for the evidence that evidence based medicine works the way it claims.
Time for Evidence Based Medicine to turn its critial focus upon itself.
Evidence Based Medicine, as the term is now used, is useful information in certain clinical situations, but not sufficient to guide clinical decisions 96% of the time. It is a reliable guide in clinical decision making when the patient in front of you perfectly fits the study criteria–something that is rare in my specialty. Nearly all of my patients would be excluded from any of the quality studies done.
We all have a responsibility to follow the reasearch, then to apply that together with other sources of knowledge to the particular patient taking into account their psychology and social situation.
“Standard of Care” is just whatever everyone else is doing, and is a concept that does good in that it keeps us from flying off on a tangent following our own narcissistic conciets, but which also impedes innovation and advance of the art and science of medicine.
Evidence-based medicine or guidelines are trojan horses for the minimalism of the HMO. In 90% of cases they serve as a spear against the doctor not as a shield in meritless malpractice cases.
The doctor should consider always cross suing the arrogant academics promulgating this anti-scientific garbage fad. He should sue the individuals and the institutional enemies of clinical care and vile HMO collaborators. To deter.
The articles reviewed for these contain parametric statistics. These accurately reflect the larger total population of similar patients.
The series of single case experiments that is clinical care has a non-parametric distribution. All guidelines therefore violate the necessary assumptioms of the parametric statistics upon which the articles rest.
Thus all guidelines are “garbage science.”
What evidence is there that one case dealt a “severe blow” to EBM?
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