Comments on: "Doctors do best when they treat their patients by the numbers" http://www.kevinmd.com/blog/2007/08/doctors-do-best-when-they-treat-their.html Wed, 15 Feb 2012 00:27:00 +0000 hourly 1 By: Mikehttp://www.kevinmd.com/blog/2007/08/doctors-do-best-when-they-treat-their.html#comment-79751 Mike Fri, 31 Aug 2007 01:07:00 +0000 http://clients.emmense.com/kevinmd/2007/08/doctors-do-best-when-they-treat-their-patients-by-the-numbers.html#comment-79751 This doesn't acknowledge that much of Internal Medicine is Psych, i.e. the "customers" are there for someone to talk to, more than to obtain a diagnosis. Or maybe they just want propecia or need to discuss diet options. None of this has anything to do with EBM, as well as much of medical practice. Patients often come without any medical illness. What robot is going to offer comfort to those who want to see a human being? This doesn’t acknowledge that much of Internal Medicine is Psych, i.e. the “customers” are there for someone to talk to, more than to obtain a diagnosis. Or maybe they just want propecia or need to discuss diet options. None of this has anything to do with EBM, as well as much of medical practice. Patients often come without any medical illness. What robot is going to offer comfort to those who want to see a human being?

]]> By: Evanhttp://www.kevinmd.com/blog/2007/08/doctors-do-best-when-they-treat-their.html#comment-79741 Evan Thu, 30 Aug 2007 17:33:00 +0000 http://clients.emmense.com/kevinmd/2007/08/doctors-do-best-when-they-treat-their-patients-by-the-numbers.html#comment-79741 For diagnoses that are definitive and easy to arrive at, I agree that EBM is the best way to go.<br/><br/>However, EBM starts with a diagnosis and for many patients diagnostic uncertainty is their paramount problem, as well as failure to respond to the treatments for the disease they are diagnosed with. In these cases protocols can be disastrous. <br/><br/>If you assume a 15% diagnostic error rate, EBM becomes less attractive because you have to filter out the 15% of patients who are being treated for diagnosis they don't have.<br/><br/>EBM is also nearly impossible to apply to extremely rare conditions. How much EBM data is there for relapsing polychondritis for example? For diagnoses that are definitive and easy to arrive at, I agree that EBM is the best way to go.

However, EBM starts with a diagnosis and for many patients diagnostic uncertainty is their paramount problem, as well as failure to respond to the treatments for the disease they are diagnosed with. In these cases protocols can be disastrous.

If you assume a 15% diagnostic error rate, EBM becomes less attractive because you have to filter out the 15% of patients who are being treated for diagnosis they don’t have.

EBM is also nearly impossible to apply to extremely rare conditions. How much EBM data is there for relapsing polychondritis for example?

]]> By: Greg Phttp://www.kevinmd.com/blog/2007/08/doctors-do-best-when-they-treat-their.html#comment-79740 Greg P Thu, 30 Aug 2007 17:31:00 +0000 http://clients.emmense.com/kevinmd/2007/08/doctors-do-best-when-they-treat-their-patients-by-the-numbers.html#comment-79740 The problem with this is the same thing that happens with standard order sets and protocols. It becomes easier to just do the protocol without understanding why. So you may have no clue when the protocol isn't working or have no alternatives. The problem with this is the same thing that happens with standard order sets and protocols. It becomes easier to just do the protocol without understanding why. So you may have no clue when the protocol isn’t working or have no alternatives.

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