Today, healthcare that delivers the best patient outcomes demands that your doctors practice evidence-based medicine. Evidence-based medicine is an approach to medical practice that optimizes treatment and testing choices through the “conscientious, explicit, and judicious use” of clinical data from well-designed and well-run research. If your doctor is practicing evidence-based medicine, he is using the best results from many people to help identify the best tests and treatments that will deliver the best outcomes for you.
The clinical research comes in many forms with names like meta-analysis, comparative effective research, systematic evidence reviews, and randomized controlled trials. This clinical research tells what testing and treatments are successful, somewhat successful, or even what doesn’t work at all. When a doctor taps into clinical research data from many patients (and doctors) across the country, he/she enlarges upon the limited clinical expertise that he/she personally brings to the medical decision-making process. When your doctor practices evidence-based medicine, you, the patient, are more likely to receive the best quality of care available at that particular point in time. Medicine is constantly improving and doctors need to keep up with the latest clinical data to produce the best patient outcomes.
Does YOUR Doctor Practice Evidence-based Medicine?
Amazingly, doctors in the United States are NOT required to practice evidence-based medicine. Our national healthcare policy has historically favored the wishes of doctors over the needs of patients for best patient outcomes. Doctors do not like to be told how they should conduct their businesses, do not want their quality of care scrutinized or made public, and are constantly complaining when government intrudes.
As private businesses, doctors can choose medical intervention (testing and treatment) choices with different primary goals:
- Intervention of low benefit (quality) to the patient, but high income to the business
- “Tried and true” interventions that may not be the “best” available, but are adequate to keep most patients happy. These are practiced by doctors who do not want to take the time, effort, and cost to learn new techniques or procedures
- Interventions designed to provide the best patient outcomes from evidence-based clinical research
If your doctor is more business-centered in the care he provides, you will have more (1) and (2) medical intervention choices as show in the figure below.
If your doctor is more patient-centered, your medical intervention choices will feature more (3) choices, some (2) choices, and no (1) low quality, but highly profitable choices as shown in the figure below.
Unfortunately, many doctors are not willing to invest time and money to deliver the best patient outcomes when a minimum standard of care is sufficient. Practicing evidence-based medicine takes a commitment to continuous improvements in clinical abilities and knowledge that many doctors do not embrace especially when the lack of local competition and patient awareness, allows them to stay with “less than best” (“tried & true”) interventions or even mix in some low quality but profitable interventions.
Given that doctors can choose medical interventions for business reasons rather than for what is best for patients, it is hardly surprising that many Americans are not getting the highest quality of care (2011 Report to Congress: National Strategy for Quality Improvement in Health Care) and a large number of Americans are even getting substandard care (see The Quality of Health Care Delivered to Adults in the United States).
Do Doctors Willingly Practice Evidence-based Medicine?
When a doctor practices evidence-based medicine, there will be situations where he must make a decision between what is best for the patient and what is best for his/her personal financial interests. For example, what happens if Comparative Effective Research (CER) data shows that a very profitable procedure (e.g., surgery for back pain) is not as good as something that threatens income (e.g., bed rest)? As with most questions involving healthcare in the United States, we only need to follow the money. The Rand Corporation concluded that
“ Financial incentives are primary drivers of adoption of new clinical practices whether or not the practices are supported by CER evidence. CER results that threaten the financial interests of a stakeholder will be challenged at all phases of the CER translation process.”
In other words, if the CER findings support increased income or profits for doctors (or drug companies or medical testing equipment manufacturers, etc), then it will be well received and evidence-based medicine will be practiced, but if it threatens income or profits, then these businesses will fight the findings every step of the way and not apply them in their practice of evidence-based medicine!
Summary—Are you getting Evidence-based Medicine?
Most doctors will not willingly embrace evidence-based medicine for best patient outcomes, especially if clinical research data threatens their healthcare business income and profits. Most doctors practice business-centered care (i.e., care that maximizes income and profits) ahead of patient-centered care (i.e., care that maximizes patient outcomes) so it is up to patients to become more engaged. You need to recognize when a doctor is delivering care that is not the best (i.e., low quality but profitable or “tried & true”). Why should doctors practice evidence-based medicine if government “intrusion” doesn’t make them? Don’t expect any help from the government anytime soon, especially with Dr. Tom Price as the new Secretary of Health and Human Services (HHS).