Evidence-based Medicine: it forgot about you

Posted on 26 May 2019

Evidence-based Medicine: it forgot about you

When you go to your doctor, you expect them to utilise the latest scientific evidence as well as their clinical experience to heal you. You go to the clinic, you’re called into the consultation room, you sit down and your doctor introduces themselves and asks you some questions:

  • Why have you come in today?
  • What previous medical problems do you have?
  • What medications do you take?
  • Et cetera…

They formulate a diagnosis and derive a treatment plan. They give you a prescription and you’re on your merry way. But wait…

Did anyone actually ask you what you want? Maybe you wanted to try without the antibiotics for your chest infection because you are worried about the bowel symptoms you might get as a side effect. Maybe you’ve just been told you have diabetes and have been thrust onto metformin but really wanted to give diet and exercise a go first. Maybe you just wanted to feel cared for. Is that too much to ask?

Indeed that’s exactly what Evidence-based Medicine is, or at least, should be. David Sackett, the pioneer of Evidence-based Medicine, described 3 components to Evidence-based Medicine: scientific evidence, clinical experience and patient values. The first two are done fairly well; however the third has largely been ignored for many years.

True Evidence-based Medicine is meant to include you throughout and all healthcare decisions are ultimately yours. Consider the following scenario:

  • Imagine you have developed early symptoms of a potentially fatal disease for which you have 2 treatment options: A or B
  • Treatment A gives you a guaranteed period of remission X but no cure
  • Treatment B gives you a 50:50 chance of ‘kill or cure’
  • How long a period of remission X to be for you to choose Treatment A rather than the 50:50 ‘kill or cure’ from Treatment B?

My answer was initially 10 years but on further reflection would be more like 30. I have a lot to look forward to: marriage, children, further my career. So I want to see plenty of that before I go.

My mentor Prof Ashok Handa has asked this question to a number of audiences in various lecture halls. Everyone’s answers are different. Everyone’s values are different. Prof (along with Prof Bill Fulford) has set up the Collaborating Centre for Values Based Practice in Health and Social Care to get this important message out to patients and practitioners so that we can practice Evidence-based Medicine as it was intended: with patient values as a core component.

So next time your doctor makes assumptions on your behalf remember that they can give you options, information and even guidance; but ultimately your healthcare is yours.