Policy experts desperately want to reduce the amount of variability Medicare patients receive.
Studies have suggested that standardizing care is one approach to control health costs, and bodies like a comparative effectiveness institute would be helpful to bring evidence to the forefront of clinical care.
That may work well for a young, healthy population, but not in the elderly. Jane Brody writes an article describing the difficulties applying “cookbook medicine” to older patients. Geriatricians “must take into account the whole picture of the patient, the patient’s family and life situation,” and that introduces individual variability that evidence-based medicine seeks to eliminate.
Indeed, we should make efforts to reduce the amount of practice variability. But doing so excessively can lead to negative consequences, especially in the Medicare population.
Related posts:
- Is evidence-based medicine desirable?
- Evidence-based medicine is hard to implement
- Marc Siegel apparently doesn’t care about evidence-based medicine
- Evidence based medicine and shared decision making
- The media vs evidence-based medicine
- Why patients will reject evidence-based medicine
- Does evidence-based medicine raise costs?
{ 6 comments }
This is a great topic that does not receive enough attention. Few cardiovascular research studies include patients older than 80; extrapolating results to this group is mere conjecture.
Why should we reduce practice variability?
Isn’t every person unique? Why shouldn’t their treatment be as well. Aren’t patients autonomous person’s free to negotiate their care with physicians? How can all those negotiations turn out the same. Don’t we all have different perceptions and tolerance of risks? and different goals? Why does a committee that doesn’t know me have the right to impose a standardized desirable outcome based on their perception of what the goals of the doctor-patient encounter should be?
I work in UM and have been a medical director in an HMO. I have went to all the meetings and seminars and heard all the “reduce variation” crap and still don’t understand the implied logic whereby it substitutes for the concept of “quality”. It is like using body counts as a measure of military success–it just doesn’t compute and leads to a loss of perception of the real goal.
The ultimate reduction in variation: all the patients die.
Isn’t much of the research tainted by financial interests anyway? Aren’t many of the big shots on the committee’s shills for the drug companies? What about the gagillion times that the consensus has been wrong. Wouldn’t the doctor who is “in variation” be the one who is doing right for his patients?
One might ask if evidence-based medicine is appropriate for anyone? I’d be curious to see Sir William Osler negotiating his way around Cochrane, P4P, NICE and whatever other acronyms are lurking about. Medicine has gone from an art based on science to a series of data points in an endless series of metanalyses. Pardon me if I’m skeptical but sometimes, as Obi Wan would say, a doctor has to trust his instincts.
I wholeheartedly agree w/ Doc99.
Sometimes I think evidence-based medicine is just a plot to forbid us docs from thinking.
Treating the herd has its place; but I treat individual persons.
Kevin, this well written New York Times article is NOT about Evidence Based Medicine. The word Evidence or EBM isn’t even mentioned in the original article, so why do you choose to use it in the title? The paper by Jane Brody is entitled “cookbook medicine won’t do it for Elderly”. She describes that a doctor should always take into account the condition of elderly patients. Some 75-year olds being active and healthy, others having complex medical problems.
As already commented on twitter by four people including me EBM is no cookbook medicine. On the contrary, EBM does take the whole patient into account along with the evidence. EBM tries to find & apply evidence that counts for a specific population. Unfortunately the evidence is often sparser for the young & old.
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