Some limitations of evidence based medicine…
Evidence based medicine
Evidence-based medicine has taken the medical world by storm in the last 10 years, yet it is actually impossible for anyone to keep up to date in their speciality, and for a generalist to keep up to date is a non-starter.
A recent comment in the newsletter for the British Holistic Medical Association sparked off a train of thought for me. The BHMA is an organisation of doctors, therapists and interested parties who are determined to keep a holistic approach to health management central. In fact, the by-line is “medicine as if people matter”. This is not to imply that non members believe that people don’t matter, but to remind us to keep the person we are talking to or dealing with central in our management plans.
The BHMA team write:
Is evidence-based medicine a reality? To keep up to date in any one medical speciality you would need to read 17 articles a day for 365 days a year. The former editor of the BMJ, Richard Smith, writes an interesting editorial article on information overload in the Christmas issue of the BMJ (BMJ2010: 341 7126). Another useful fact is that only 30% of recommend medical treatments in practice are evidence based.
My take on this subject:
Until 2005 I was convinced that I had to keep up to date with everything. By that time I had about 200 various medical journals and magazines piled high in my house – the ones I had not managed to read.
Let’s face it, as a doctor, every medical journal I picked up had something that I felt I “should” know and didn’t. In 2005 I let go of my ultra perfectionist, logical tendencies for ever. For the first time, I accepted that I would never be the “perfect” doctor, and while always striving to improve, I could safely let go of perfectionism and be happy to be “good enough”.
Having let go of that perfectionism, I am happier, easier to live with, easier to work with… the list is endless. In our world of information overload, an understanding that we can never know everything is fundamental to survival. I have survived, and I feel that I am a better doctor, employer, wife and mother as a result.
As for the fact that 30% of medical interventions can be said to be “evidence-based”, this is absolutely true. I tried to point this out in a discussion on a forum a few years ago, but found myself shouted down. If you take evidence based medicine in its purest form (which I believe removes our ability to heal ourselves from the equation), it is not possible or ethical to do trials of certain established interventions.
How would you like your child with appendicitis entered into a randomised controlled trial of appendicectomy versus “sham” surgery. just to see if the appendicectomy patients fared better? It would be a non starter, and put your child at risk.
This debate will go on and on, but I just wished to highlight that we doctors (and I’m sure other professionals such as lawyers and accountants) are overwhelmed by information. I also feel that this is the reason why most doctors do not have time to make themselves aware of the huge evidence base in favour of lifestyle advice and nutritional supplementation, as well as other complementary therapies, for patient care. Again, a debate that will run for decades.
For now, have a great week!