Wednesday, June 2, 2010

There is a lot of gray in medicine

A significant saving in health care costs in the U.S. has been produced due to the increased incentives tied to the use of evidence based medicine-driven protocols. An article I read recently entitled “Rational Arguments – Evidence is Only one Part of the Story,” clearly highlights the challenges that evidence-based medicine and their outcomes will face.

For me, it was again a reminder that although we would like medicine to be black and white for both providers and patients, that in reality it clearly exists in a grey zone. It also is a stark reminder that technology-driven diagnostic tests are rarely a completely, 100 percent accurate diagnosis for a patient’s symptoms, and the final treatment plan must be devised by coupling the diagnostic study with the physical examination. Therefore, arriving at the best treatment plan—somewhere between the totally subjective and objective—must be done in the gray zone.

What does this mean? Should we walk away from the research studies that are described in the article? Should we forgo seeking the best clinical trials to guide us to the best treatment plan or drug? Because a large percentage of patients will not follow proposed treatment plans which they know will improve the quality of their life, should we decide that the effort of seeking the evidence is not worth it?

We all know the answers. We must continue to get providers to follow well-proven practices so that more consistency and predictability in the appropriate mix of studies, supplies and treatment plans will occur. This approach will result in a reduction of overuse, underuse and misuse of health care resources, which ultimately will lead to a higher quality, lower cost health and wellness outcome.

Secondly, we must continue to educate the patients with data on what would be in their best interest to keep them as healthy as possible and symptom-free. Recognizing that achieving 100 percent compliance is an issue, and will never be reached, we still need to always do what is right, and recognize that improving the health of a large population will always be done one patient at a time.

Clearly the article is correct—evidence is only part of the story. Pneumonia can mimic gall bladder diseases. “Heart symptoms” can be attributed to gastrointestinal disease, and a migraine can masquerade as a temporary stroke. This gray zone will always exist in medicine, but by collecting more and more evidence and sharing this information with both providers and patients, I firmly believe that the gray zone will be significantly narrowed, and higher quality/low cost health and wellness care will be the result!

1 comment:

Joshua said...

Well said. I am a medical student here in town and I could not have said it better myself.