Evidence Based Medicine

To my patients,

As you know I usually email you with a response to something Gynecologic that has appeared in the news. This is somewhat different. The following was written by Dr Lisa Larkin, an internist in Cinncinnati who is a colleague and a very good friend. Recently (finally) she was elected to the Board of the North American Menopause Society (as most of you know I was President of that Society) and is a speaker on relevant internal medicine topics at the course I co-direct “Survival Skills for the Practicing Gynecologist.”

It so epitomizes what I do in my office that I wanted to share it with you…

“WHAT IS “EVIDENCED BASED MEDICINE”?

Medical information these days is at our fingertips. It’s easier than ever, it seems, for patients to investigate their symptoms and discover new treatments from a variety of sources.

Meanwhile, a staggering amount of scientific research is being published daily for healthcare providers to read, synthesize and apply to their practices. With this wealth of new data comes an urgent need to understand how our patients can most benefit from emerging research.

ENTER EVIDENCE BASED MEDICINE

Evidence-based medicine is a context by which a clinician can determine the most effective course of treatment for each patient. It combines: (1) the best research-based evidence available for their patient’s medical concerns, (2) the patient’s values and preferences surrounding their care, and (3) the clinician’s own expertise and experience.

A SYSTEMATIC APPROACH

Let’s break that down. Say, for instance, a patient is diagnosed with diabetes. A doctor using evidence-based medicine could ensure she or he was up-to-date on the latest diabetes literature because this approach uses systematic reviews and analysis to evaluate the current best medical evidence on specific topics.

This information is vetted and agreed upon by peers. Generally, where there is evidence a treatment works, it is used, and where there is evidence a treatment does not benefit the patient, is not used. In fact, healthcare providers have created specific, evidence-based care management programs for many diseases, including diabetes. Where there is not enough evidence, a consensus is developed among healthcare providers on a careful course of action.

SHARED DECISION MAKING

Using this approach, an evidence-based medicine provider would also listen to their patient, understanding their patient’s specific concerns and any other factors that could affect treatment.

Finally, the clinician brings their acquired knowledge and skills into this conversation, and together, the clinical and patient determine the most effective treatment plan going forward.

BETTER OUTCOMES

With so much information related to health and wellness being presented in the media, it is not uncommon for patients to see a story or advertisement and naturally wonder if they might benefit from a treatment or product described. Additionally, some patients researching their own symptoms or listening to family or friends’ opinions about particular treatments might feel overwhelmed just by the amount of data available.

Evidence-based medicine presents a real, systematic course forward that has been found to improve a patient’s overall care. Studies looking into this approach have found it has led to measurable improvements.

Great healthcare is backed by evidence and determined through conversation between provider and patient. Talk to your provider if you have questions or concerns about your treatment—it could contribute to better overall health.” I know this was a bit long but hope you appreciate what people like me and Dr Larkin are still trying to do in our care for patients.

Dr Steven R. Goldstein is one of America’s top gynecologists and a Menopause Specialist in NYC .