Monday, March 17, 2008

EBM ( Evidence Based Medicine) versus POM ( Peace of Mind)

EBM ( evidence based medicine ) is all the rage now. This refers to the provision of cost effective, appropriate medical care to patients, and is the "scientific" way of practising medicine. While this is true, we need to remember that medical care is more than just a science - it's also an art, and there are times when EBM may not be the best option .

For some patients, a better alternative maybe what I call POM - Peace of Mind medicine . This refers to treatment options which may not be the generally accepted norm , but maybe the best alternative for the patient, given her individual circumstances !

Medical care needs to be personalised and individualised - and while EBM is great when dealing with groups of patients; or in areas where the evidence is unambiguous, EBM is often not the best option in all circumstances.

POM allows us to take the patient's feelings into account, so that she can provide her own inputs into the treatment plan. For example, consider a women who has an elevated FSH level of 15 mIU/ml. She has poor ovarian reserve, and her chances of getting pregnant with her own eggs are very poor. EBM recommends that we do donor egg IVF for her, but this is not an option she is willing to consider. The simplest course of action is to refuse to treat her - but is this the right thing to do ? As long as she has realistic expectations and understands her chances are poor and still wants to go ahead, are we justified in refusing to treat her ?

Doing IVF with her own eggs may not be EBM, but it will give her peace of mind she did her best. It is POM medicine - and while outcomes with EBM are always uncertain, the peace of mind which POM provides is priceless !

POM allows to to offer personalised medicine and lets patients make their own decisions ! Why should we take away their choice ?

No comments:

Post a Comment

Get A Free IVF Second Opinion

Dr Malpani would be happy to provide a second opinion on your problem.

Consult Now!