Contrarians would be served best by channeling their energies into demanding improvements to the implementation process, rather than mere resistance to evidence-based medicine itself. It’s all part of the time-consuming maturity of a good idea.
And mature it must. “We shouldn’t have to wait for a generation to pass when new practitioners take over before the new evidence is in place,” says Haynes. “It has to be generated at a much faster pace. We don’t want to kill the old practitioners; we want them to catch up.” To be sure, evidence-based medicine offers structure to the complex world of modern healthcare, but it’s far from a cure-all. Pamela Wible, a family physician in Eugene, Ore., notes that it’s “an imperfect tool. It can inform, but it should never dictate. Medicine is an art, when you really get down to it.”
Think of the limitations of evidence-based medicine as a canvas upon which you do your best work. Sometimes, there will be a dearth of evidence to support your decisions.
Granted, change is difficult, and you need time to learn, acknowledges Haynes. “It’s quite difficult to pick up a new way of managing patients — particularly if you’re on your own — or a new drug from a treatment you’re already used to managing. You have to remember how to spell it when prescribing it. You have to remember what to say when the patients ask what the side effects are. You don’t have experience with the drug.”
You’ll also find that people rarely fit into the same mold. Compliance is a particularly unruly wild card. Even if you do determine a certain course of action to be the most effective, says Ott, “if a patient is not organized enough for a certain blood pressure medication, then you make a decision for the ‘best’ treatment. The most important thing is that the blood pressure be treated.”
“You’re not always going to have a study — nor do you need one — for every patient,” Ott adds. “That’s really important to the art of medicine.”
The art, of course, lies within you, when you’re faced with a sick patient and uncertainty swirls about while you decide on a treatment course. You can — and should — turn to techniques and methodologies to assist you in that decision. But in the end, the pressure’s on you to make the right call on behalf of that person.
And that is why evidence-based medicine will never replace actual doctors. We will always need human beings to treat human beings. “I wouldn’t go to a doctor who didn’t have the expertise or experience in the condition I’m trying to get help with. That can’t be replaced; it’s essential to solving health problems,” says Haynes. “But evidence is also very useful in doing that. They’re not against each other, they’re not either/or. The two of them together, expertise and evidence — that’s going to be the best recipe for improving a person’s health.”
Shirley Grace is a former associate editor with Physicians Practice. She can be reached via physicianspractice@cmpmedica.com.
This article originally appeared in the April 2009 issue of Physicians Practice.
