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Reflections on Evidence Based Medicine

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Describe evidence-based medicine?

Evidence-based medicine uses the randomized, double blind, placebo-controlled study to determine what modalities are safe and effective, when the modality being tested is pharmaceuticals.  This model is being expanded to encompass testing procedures, imaging, and surgical procedures. This is the current paradigm for determining what is safe and effective in medicine. It changes every few years or so. All other possible modalities, that don’t fit into this model, are often considered, unscientific, unsafe and ineffective, and may be up for election again when the trend in medicine changes.

What does this imply beyond the procedure? Or how I see it.

For me to be able to look at evidence-based medicine objectively, I have to put aside some of the assumptions that I think it implies.  One being that it is the only way to evaluate a treatment, and anything that can’t be adequately evaluated, by this method is invalid therefore ineffective and unsafe.   Also this implies the idea that the patient is uninformed and therefore needs to be told what to do regarding their health choices. Some patients may feel intimidated into an immediate decision without adequate information about their options.   With the consumer age and information technology as it is the patient is often as informed or more about their particular condition than some of the physicians they will see. In this way evidence-based medicine is elitist over the general population that it is suppose to serve.  This particular model has a gap, not taking into consideration that research participants are often healthy and not taking any medications and the target prescription will actually go to, ill people, are on multiple prescriptions.

What are some ideals for Evidence based medicine?

For me to reflect on evidence-based medicine I have to reflect on my basic beliefs on medicine and healing, remembering that my primary mission as a health care provider and a healer is:  to make sick people well, prevent illness, act as a teacher, live in accordance with nature, and teach patients to do the same, do no harm and trust the body’s innate ability to heal, to name a few.  If and when evidence based medicine is working to embody all, or some, or even one of these basic principle, it is working for the good of the people.  This doesn’t mean that other forms of knowledge be ignored, abandoned or disqualified.  It is not the only way. 

Evidence based medicine and holistic medicine should have a relationship that mutually inspires the other to be stronger like yin and yang continually nourishing and strengthening the other. This should lead to better services, options, and modalities for the patient.  (After all there may be a time where our friend, family, loved-ones or ourselves will be in need of care and we will want only the best, most effective, non-harmful, low-side effect, comprehensive and compassionate care).

The ultimate goal (in my opinion) is the best possible care for the patient, who is able to make the most informed decision, on what is best for them.

We are living in a health-care period where one size fits none. Much of the population doesn’t have adequate health-care options. Doctors are not being served in this model as well as patients.  Many doctors work long hours, with heavy patient loads, high loans, low sleep and job quality or satisfaction.  People go into the health care profession to help people and are offered our current system of the seven-minute visit leaving patients with one or more prescriptions.  Neither the doctor or patient is served very well.

In a more balanced situation what would evidence-based medicine look like?

It is widely accepted that health is not only the absence of measurable disease.  It is more than just taking a pill.  Evidence-based medicine is a part of a system, a part that should in its structure and function mimic the whole system, a microcosm within a macrocosm, mimicking that, which exists in nature. It is one piece of a large and complex system called healthcare that may be out of balance for what is currently able to provide for the patient population, in terms of patient satisfaction and clinical effectiveness. 

As a students, and consumers of non-standard health-care education, we need to take that which is useful to us so that we can serve others.  That should mean taking things like evidence-based medicine and understand what is useful about it and combine it with our ideas to form new ideas.  Owning our knowledge in essence.