The NEJM is surprised that not every doctor follows EBM like gospel, again showing the disconnect between academic medicine and the real world:
“What we learned from this is that evidence-based medicine is easy to talk about but hard to implement,” editor-in-chief Dr. Jeffrey M. Drazen said in an interview.
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- Marc Siegel apparently doesn’t care about evidence-based medicine
- Why patients will reject evidence-based medicine
- NEJM vs The Supreme Court
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As a medical librarian it seems like some professionals have always been more evidence based than others. They perhaps had to work a little harder at it. With the current model of electronically pushing the evidence out to practitioners, some of the “seasoned” physicians are offended. I have heard it called “cookbook medicine”.
With the “evidence-based” approach, I’ve wondered how much more objective it would seem to make the art of practicing medicine. If you can put all of this into a computer, and get back the latest “evidence-based” recommendation, it begs two questions:
1. Why have physicians if your diagnosis and treatment can be managed by computer?
“Because you can’t anticipate everything in every combination!”
2. So you keep physicians, and they extensively use evidence-based recommendations, but what happens when the physician decides to stray from those recommendations, based on those human qualities we wanted to keep him around for? Wouldn’t that be a big red flag for a jury at a malpractice trial?
Just one more way to squeeze.
It seems to me that, like other good concepts, EBM is going the way of facile simplification. For example, EBM is not about just uncovering the evidence, but rather it is about the critical assessment of that evidence. After all, science yields but an approximation of truth. EBM can tell how close.
It may guide and inform how one deals with a patient, but it can dictate nothing.
I once heard (and I should probably attribute the quote properly… apologies) that “EBM is the beat, the art of medicine is the melody.”
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