Thursday, February 09, 2012

Judgment based medicine versus evidence based medicine

Modern medicine is based on scientific principles . This can be very reassuring for patients , because they know that doctors have a body of evidence which they can trust ; and use logical principles in order to treat them correctly. However, medicine is not an exact science. It's an uncertain science , and this is hardly surprising given the fact that we're applying this science to a complex biological system - the human animal.

Doctors are used to dealing with this kind of biological variability because they spend so many years in medical school ,learning that they can be a lot of variation between the way patients respond treatment. However, when it comes to insurance company bureaucrats , policy wonks, and hospital administrators , this kind of complexity makes them extremely uncomfortable . They are much more comfortable handling numbers , which are much more predictable ! This is why they would rather deal with cut and dried systems , which make logical sense on paper. This explains why protocols and flowcharts and algorithms and guidelines have become so popular . Doctors today are being pushed into practicing medicine using published guidelines, rather than their own personal judgment or clinical intuition . This is why the movement towards evidence-based medicine has become so popular.

If you have a rigid yardstick to measure doctors by, it's easy for clerks and pencil-pushers to see whether doctors are performing according to that yardstick ! Those who do can be incentivized to continue doing so; whereas those who don't can be appropriately penalized . Evidence-based medicine has been thrust upon doctors and patients , not because it's better, but because it easier for non-doctors to manage, because it's less messy than real life medicine ! It's has been dressed up as providing patient centered care while it's really system centered care.

The difference between the two is highlighted very well by Doctor Groopman in his book, Your Medical Mind . He criticises the modern fashionable trend towards evidence-based medicine , where all patients are treated like widgets. We cannot afford to continue to pretend that one-size-fits-all ; and that if the guidelines are followed, all patients will behave exactly the same way . Since Doctor Groopman is a practicing physician who deals with the uncertainty and orneriness of real life medicine daily. He feels that doctors should be allowed to apply their judgment , so that they can tailor evidence-based medicine to an individual patient, and practice what he calls judgment-based medicine.

This is what you should ask for the next time you visit your doctor !

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