EVIDENCE, SCIENCE OR ANECDOTE/GUESSWORK FROM YOUR CAREGIVER???

Do we need evidence based medicine (EBM)?? My recent post on the need for evidence based medicine has created some of the typical responses from physicians which I would like to address head on

Some argue that the skill of the bedside physician should not be second guessed. That skill and judgment is highly suspect. I sincerely believe in Bayes theorem and the skill of expert physicians who may rely on their "gut" to order that additional test which may not fulfill the criteria of EBM but statistics and facts prove the need for EBM. By definition half of all physicians are average or below average. The ongoing loss of clinical skills and judgment has been written about extensively with greater reliance on lab tests and imaging. The use of unnecessary tests and therapies is epidemic and the data supports this.

Second, some raise liability concerns as an issue and that much additional therapy and testing which is not EBM is needed to protect against lawsuits. This is a profound myth!! I will state categorically that your liability exposure is infinitely higher by not practicing EBM. Finally I see the use of anecdote as an excuse for not using EBM and ordering unproven/suboptimal care. Anecdotes pollute the literature. We need to do what science has shown to be safe and effective not what a few cases possibly suggest. I have been in the trenches for the past 30 years and the loss of life due to not practicing EBM is staggering.

Patients need to demand EBM from their caregivers. Physicians and other providers need to adopt the role of scientists and practitioners of data driven care and stop the practice which states as its mantra "That is the way I have always done it or that was the way I was trained" Lastly the simplest solution is to not reimburse for care that is not evidence based!!