Wednesday, January 17, 2007

EBM: A Balanced Approach?

Okay, I may be making a huge ass out of myself for posting about Evidence Based Medicine but I've been doing some reading and it's kind of bugging me. I'm not a health practictioner (as my blogger name says!) but I am health consumer.

So I've been trying to wrap my head around EBM and all the fuss. I've been reading both sides of the argument and really, I can see where it works in theory but not always in practice?

Of course it's always good to pay attention to studies and be "judicous" in looking at them (that word comes up a lot in EBM) but isn't there more to practising medicine? It's not just about the facts and figures and statistics. I know proponents (or even non-proponents) of EBM may be laughing at me right now, saying that I'm totally taking it out of context and I have no idea what I'm saying?

And yes, there are people out there that claim to be "experts" that do need to be weeded out so yes, cite your references, always. But that's just common sense! If I read someone who claims to be an expert, I want to see their data.

But I think you also need to take into consideration so many other factors that EBM just doesn't allow room for. I'd be an EBM nightmare. Co-morbidities, taking meds off-label--but they work! I'm living proof! But according to EBM, I would not fit the criteria, therefore I may not be able to take my precious Topamax/Topiramate if one of my docs was a real EBM hardass! Well, perhaps I could...if I armwrestled him/her.

I somehow feel that EBM as a "movement" as it has been termed has the capability to go a little too far. From what I gather, they deem what is appropriate in terms of evidence and dictate proper guidelines. It just feels a little too militaristic.

Yes, there are "rules" to science but healing is an art. Let's not lose that in the overall approach to medicine. Let's not completely put the blinders on and have professionals buried in the latest "research" looking only at that (which may only give a partial picture, anyway.) Supposedly, EBM doesn't preclude the patient but it doesn't exactly give me a warm feeling.

Alright, ending this now. I'm just a patient.


~Just Michelle~ said...

EBM sounds like the perfect criteria for the HMO's to use to dictate treatment to patients.

Doctors should be VERY careful about following this particular trend because if it really takes off then it won't be very long before the doctors themselves won't be needed anymore! We'll just punch our symptoms into a computer and it will spit out our diagnosis and prescription just like the receipt at the ATM and gas pump!

Oh, btw, this is the teacher michelle (Quote blog) who jumped here from the other Michelle's blog. Sorry to add more confusion in the names!

Rob said...

I have a totally different take.

I had a person at an HMO tell me I could not order something because "they used evidence-based medicine," and my thought was, "gosh, I was using Tarot cards to decide...maybe I should change."

To me, Evidence-based medicine is a redundant statement. It just means "scientific medicine," and medicine is based on science - use of observations and evidence to form provable conclusions. I think physicians resist it because they don't feel comfortable being pushed to a higher standard.

Believe me, you want to go to a physician who practices EBM. Some of that evidence may be from personal experience and sometimes the evidence is sparse, but it is far better than doctors not following what the best evidence says.

I am just about to launch into a series on this on my blog.



Patient Anonymous said...

Thanks for your comments, both of you. I was very curious to see if anyone would respond!

michelle, I think I've got the two of you sraightened out now *grin*

I look forward to reading your piece rob.

As my title stated, I am not completely against EBM, per se...just, I suppose, pro-balance in treatment? It was just rather interesting to see how people were so driven to taking sides on the issue. I don't know if I've made myself any clearer or just muddled things further. Ack!

And indeed, tarot cards wouldn't exactly thrill me either. I could simply treat myself at home then and dispense with doctors altogether haha(?)