Thought this might generate some interesting discussion...

[PJmomrunner]

I read this a couple nights ago:

"A bold new way of thinking has taken the medical establishment by storm in the past decade: the idea that decisions in medical care should be based on the latest and best knowledge of what actually works...." Many good doctors are a part of the "growing number of physicians joining the movement..." and they are "committed to identifying, disseminating, and, most importantly, applying research that is soundly conducted and clinically relevant. If all this sounds laughable to you--after all, what else besides evidence would guide medical decisions?--then you are woefully naive about how doctors have traditionally applied their trade. Yes, the research is out there--thousands of studies are conducted on medical practices and products every year. Unfortunately, physicians don't use much of it. Recent studies show that only about 15% of their decisions are evidence based. For the most part, here's what doctors rely on instead: obsolete knowledge gained in school, long-standing but never proven traditions, patterns gleaned from experience, the methods they believe in and are most skilled in applying, and information from hordes of vendors with products and services to sell."

(Written by Jeffrey Pfeffer, Thomas D. Dee II Professor of Organizational Behavior at Stanford Graduate School of Business as printed in the Jan. 2006 issue of the Harvard Business Review.)

 

[Phyllis]

That's why patients are their own best advocates and must do their own research as well- that and picking the best doctors will see us through!

 

[geebee]

Novel concept but it could deflate many doctors' God complex if they have to rely on evidence vs the idea that they come out of med school knowing it all.

 

[PJmomrunner]

The article was only using the medical profession as an example of what businesses as a whole tend to do. It really speaks to the fact that we are all human--even doctors--and that only a subset of humankind follows evidence based practices in business, or anywhere else.

Geebee, yeah! You think we could get all the docs to wear buttons that say, "All I Ever Needed to Know I Learned in Med School," or "I Practice Evidence Based Medicine?" It sure would make it easier to find the good ones.

 

[Nancy]

I guess this doesn't surprise me. We are all creatures of comfort. When you have always done something a certain way, and never gotten into trouble doing it that way, you are loathe to try something new when you aren't sure what will happen.

An oldtime doctor that Joe had many years ago used to have some precious phrases. One of them was, "We aren't playing Tiddly Winks here, you know". But then again, this same doc sometimes prescribed meds that weren't made any more. The pharmacists would laugh.

It's better to battle the devil you know, than battle the devil you don't know. But then progress will never happen. If it weren't for some cutting edge meds just out of clinical trials, Joe wouldn't be here.

This is why all doctors should do their level best to keep up with ongoing training every year.

I was a commercial interior designer, and even we had to keep up with things through CEUs to keep our certificates up to date. Other professions are the same way, so why not doctors?

 

[Georgia]

Only a profession mired in outmoded practices would consider "basing its decisions" on that which works would call this a "bold new way of thinking."

Ugh - doesn't it just give you the willies? These people have scientific backgrounds, and they just don't want to change.

 

[RCB]

How true!

How true!

"For the most part, here's what doctors rely on instead: obsolete knowledge gained in school, long-standing but never proven traditions, patterns gleaned from experience, the methods they believe in and are most skilled in applying, and information from hordes of vendors with products and services to sell"

One of the best example of this is pediatricians? attitude about circumcision.
For years the American Cancer Society had been urging the Pediatrics
Association to change their policy statement regarding the need for circumcision.
Finally, the ACS re-released several studies which debunked a commonly held
belief that circumcision prevents penile cancer. The pedestrians had egg on their
face when they immediately changed the policy, stating there ?was no medical need
for circumcision?, because word got out that the ACS threatened a study to see if
there was a profit motive behind the foot-dragging.

 

[tobagotwo]

I agree in large part with the article's basic concept. I am a tough patient to deal with, when I don't think the doctor is applying his brain cells fully.

I never go to a doctor insisting he "do" something. If a doctor always has an answer, I lose my faith in him quickly. If the doctor seems to be deciding how much he's going to tell me, I disappear off his patient list. If what a doctor says to me is plainly malarkey, I say so - plainly.

While we're certainly not cardiologists, many here know at least as much as most cardiologists do about certain, narrow aspects of valves and valve problems, and are probably more up-to-date about thise limited areas than most cardiologists are. Not with the full, base understandings of overall heart function and conditions that cardiologists should have, but with enough competence to add meaningfully to their care. 'Tain't heresy. It's all there to be learned by anyone. Cardiologists have to know about a lot more aspects of the heart than just valve problems, so their attention is split.

This is a roundabout way of saying that I believe in partnering with your doctor, if you're able, rather than simply deferring to him. If you were his only patient of the morning, or his main "project," perhaps it would be different. But you are one of many patients, each with different issues. It would be inhuman to expect that the doctor should be an expert in each and every area in which he must practice.

Sometimes there is no time or choice, and you must rely solely on a doctor's judgement. The rest of the time, if it suits your personal philosophy, it makes sense to be involved as much as you can. After all, your doctor sees you for fifteen minutes, tops. You see yourself all the rest of the time. Who knows you better?

Best wishes,

 

[Karlynn]

I don't fault a doctor who continually goes back to what is Tried and True for him/her, if they've been successful with that approach. I do have issues with those who view new, uncontroverted evidence and still won't change their mindset. Those of us that use Coumadin run into this all the time. A doctor telling someone on Coumadin they must use an electric razor - PLEASE!

I've had doctors who've practiced the same way for years, but keep current on medical advances, and I've had them who wouldn't know what JAMA was if it hit them in the face.

 

[BillCobit]

That's why patients are their own best advocates and must do their own research as well- that and picking the best doctors will see us through!

WELL SAID! (drives me nuts everytime I read a post about someone putting blind trust in their cardio when the doc's guidance is apparent cr@p)

The really good news is that the Internet and forums like this enable us to do exactly what Phyllis says.

PJ, too many of us know firsthand that the phenom you describe is prevalent in business (med or otherwise) - but the stakes are obviously really high in the mdeical field. BTW - you've got really beautiful eyes

Cheers,

 

[PapaHappyStar]

I wonder when a good AI learning based diagnosis program will be available to help human physicians. E.g. a large database of pateint records with data mining algortihms that look for correlations in patient medical history based on past records etc. -- sort of like google for medical information. I think there are people working on this in the NIH. A recent grad was hired from here to work at NIH in medical informatics.

There is plenty of data available in hospital records -- needs a lot of man/computer power to sift through, will be an interesting development...