How long does it take for a new treatment for a given disease to make its way into routine patient care — after it’s been proven to be more effective than the previous standard? About 17 years, according to the Institute of Medicine. That huge lag time between the reaching of conclusive evidence for a new protocol and its inclusion into ordinary practice is one big reason that protocols in many practices are obsolete or incomplete, the IOM claims — with only half of today’s patients with many common diseases receiving adequate care.

What’s the problem? Is the research industry failing to get the word out? Nope, just the opposite, in fact. Modern physicians are drowning in a sea of information — and all of this new data is presented as vitally important (though a good bit of it is actually pure dross).

For primary-care physicians alone, that means reading about 90 journals regularly just to keep up. That’s about 15,000 articles per year, or 40 a day — in their spare time.

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Let your voice be heard

Enter evidence-based medicine. The idea is to provide a framework for treating your patients with the latest proven research backing you up. Most physicians are aware of the evidence-based medicine concept, now 16 years old, and agree with it in principle. What doctor wouldn’t want to apply the latest proven treatments to patient care? And yet, the fact is that evidence-based medicine has not been fully embraced by many physicians — at least, not in practice.

What’s the problem? And how do you bring such a strategy into your practice and still have time for your family and a decent night’s sleep?

A quick primer

The end of World War II marked a turning point for medical research; many countries began investing earnestly, and by the 1970s, there was more information wafting about than any physician could reasonably absorb. “So we took it upon ourselves to try and help with that,” says internist Brian Haynes, a professor at the Michael DeGroote School of Medicine at McMaster University in Hamilton, Ontario. David Sackett, a physician who founded the department of clinical epidemiology at McMaster, pioneered the research effort that led to the development of what was dubbed (in 1993, by fellow researcher Gordon Guyatt) “evidence-based medicine.”

Evidence-based medicine is a systematic, corroborative method of practicing in which your medical decision making is supported by facts. By using evidence-based techniques, you can go beyond using just your current clinical knowledge and experience.

Its proponents argue that evidence-based medicine is not a replacement for the way you practice medicine; it’s an enhancement. You are, in essence, bringing in evidence that gives credence to whatever medical decisions you need to make for your patients.

It is not “cookbook” medicine, as some critics have complained. Evidence-based medicine evangelists note that if you practice with the stance that “that’s the way I’ve always done it,” you’re behaving more robotically than if you incorporate evidence-based protocols, through which you open yourself up to new ideas and scientific exploration. “The evidence is just a tool that can be helpful in some patient situations,” says Haynes. “We’re not inventing a new way of practicing medicine. We’re simply trying to get evidence wedged into the process to support the clinical practice.”

Evidence-based medicine is a logical progression of steps — rules, essentially. Say, for example, you have a 24-year-old male patient with a history of narcotic dependence for back pain. He presents with shortness of breath and increased fatigue five days after his long-acting oxycodone dose was increased. During his workup, which includes an echocardiogram showing cardiomyopathy with ejection fraction of 10 percent, he develops a fever of 39.6 degrees Celsius. Using evidence-based medicine protocols, you would:

 

• Formulate a specific clinical question based on a particular patient problem to drive your inquiry. The question can relate to diagnosis, prognosis, treatment, outcome, or any other cogent factor — whatever makes sense for that patient. In this case, you might ask, “Will gentle exercise help, or more meds beyond the beta blockers?”
  
  
• Search current literature for relevant information. Technology is extremely useful here, which we’ll discuss below.
  
  
• Evaluate the evidence. Is it valid, useful, and pertinent to your patient’s situation? After a thorough evaluation of all found studies, you know that yes, there are some additional medications from which he could benefit. Strict compliance is essential. Physical therapy has also shown to be helpful, albeit somewhat less so.
  
  
• Decide how you’ll treat your patient. You know your patient better than any preponderance of evidence. Suppose this patient struggles with both finances and treatment compliance. Knowing that, you decide to try the physical therapy first — it’s cheaper for your patient and more likely something he’ll do.

That’s about it. You stay in complete control of the clinical issue and its resolution. Perhaps you know this particular patient lives too far from the facility he’d need to frequent for the best treatment, or the most- recommended treatment is formidably expensive, and the second-best one is a fifth of the cost. Now you’ve got a set of facts that address risk and feasibility that you can discuss with your patient, and settle on a course of care.

Some realities

So that’s all well and good for one patient, but what if you’ve got 2,500 active charts? You certainly don’t have time to slog through voluminous piles of research every time a clinical situation presents itself to you. “It’s like drinking out of a fire hydrant,” says Chrissie Ott, a family physician from Portland, Ore.