Hi, I'm Dr. John Shim, and today I'd like
to talk about a rather boring topic, and that's
the discussion about evidence based medicine.
To many this seems like a buzz word, or a
way to justify certain treatments.
In reality, evidence based medicine is the
more modern way to determine if clinical decisions
are based on supporting scientific data instead of just pure tradition and medical art
form.
While I'd like to say that the current modern medical treatments are based on scientific
data, the reality is many of the accepted
practices are based on community standards.
While they maybe had some sound reasoning for doing these community standard treatments,
unfortunately, it's hard to know if these
community standards are actually based on
scientific data.
Let's give an example, in reality the use
of antibiotics for many common respiratory
conditions is probably counterproductive,
and may potentially cause more issues in the
future.
While bacterial infections can be eradicated by antibiotics, the right antibiotics must
be chosen.
If the infection is a viral one, antibiotics
will not do anything to help that situation.
The reality is antibiotics have been over-utilized, and as a result there are now many resistant
strains of bacteria out in the community.
These resistant strains are becoming more and more difficult to treat.
Many now believe the common practice of treating common colds with antibiotics added to the
development of these resistant strains.
With evidence based medicine analysis, we now know that 30% of all antibiotic prescriptions
may not be necessary.
With evidence based medicine, up to date physicians will make recommendations based on the latest
scientific data, and not just based on tradition, or trained learning - learned years ago during
their residency.
Of course, the tension is the anxiousness
of the person with the cold, and also the
confidence that person has in their doctor.
If there is no confidence, usually that person will demand antibiotics, and because it is
easier to write that prescription than to
take time as a physician to explain why the antibiotic will
not likely work.
In a small percentage of time, the doctor is in an unfortunate “I told you so”
situation where a small percentage of colds do become bacterial infections.
For people with neck and back pain, community standards can potentially lead to over utilization
of many spine related treatments and activities.
Evidence Based Medicine suggests that there has been significant over utilization of tests
like x-rays, MRI’s and CAT scans to try to
determine the cause of neck and back pain.
For the vast majority of neck pain, back pain, and sciatic nerve pain, the episodes usually
resolve within 6 to 8 weeks.
There are many examples of people getting very expensive, and potentially risky tests and
procedures for neck and back pain, but then their pain resolves even before finding out
the results of the test.
The evidence supports waiting and using common sense approaches like gentle stretches, over
the counter medications, and activities modifications while waiting for improvement.
As in the example of the cold, it takes time for the Doctor to explain why the testing
may not be necessary at the time of the appointment. Sometimes it's just easier to order the test.
Also, in certain instances, there are incentives to order those tests.
After all, the MRI machines, and the diagnostic facilities do take funds to operate.
In my opinion, evidence based medicine has its role, and health care best practices do
prevent unnecessary testing or procedures.
Still, the role of a specialist is to determine when a person has a situation that falls outside
the parameters of these best clinical pathways.
In the end, Evidence Based Medicine does provide a good guide for common situations.
If you are responding to the Evidence Based Medical protocols, it works out for everyone.
If you do not respond accordingly, then the expertise of an experienced Doctor can help
you step out of the protocols to help you
find your diagnosis or solve your current
medical condition.
While I'm very supportive of Evidence Based Medicine, I also know the Evidence has changed
for many conditions. We all know that the recommendations for eggs, hypertension, things of that nature changed over the years. Yet, we have to go by the evidence.
There remains a significant role for Specialist Doctors, even in this Era of Evidence Based
Medicine, Artificial Intelligence, and Dr.
Google.
I am Dr. John Shim, discussing Evidence Based medicine.
I hope you found the discussion interesting.
Thank you.
