Conflict Between Evidence Based Medicine – Patient Centered Based Medicine Why it is important

Evidence based medicine is the integration of best research evidence, with clinical expertise, and patient values. Evidence based medicine, a process of turning clinical problems into questions and then systematically locating, appraising, and using contemporaneous research findings as the basis for clinical decisions. Population based outcome research has repeatedly documented that patients who do receive evidence based medicine have better outcomes than those who don’t.

Patient centered medicine is providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.   It empowers the patient to assure the patients preferences are taken into account. Similar to the U.S, Declaration of Independence it should be self-evident that a patient centered approach has successful outcomes. However there is evidence from research showing patient centered medicine has advantages of greater patient satisfaction scores; better patient compliance; higher self-reported functional outcome scores, and fewer malpractice claims against healthcare providers.

Ideally the paradigms of evidence based medicine and patient center medicine should be complementary and synergistic. In reality they can be at odds. The focus of evidence is pathology oriented not patient oriented. The healthcare provider uses evidence to make recommendations to the patient, and the recommendations may or may not match the patients’ values and expectations.

The potential discord between evidence based and patient centered approach is becoming more common because of the cost factor. Often patients desire and expect multiple expensive diagnostic testing and the latest and most expensive interventions. Yet the best available evidence may document better outcomes with fewer less expensive diagnostic tests, less expensive interventions. Health insurance companies often deny payment for treatments which lack evidence of effectiveness. Many of the complementary and alternative based interventions do not meet the standards of evidence based medicine. With more of the costs of health insurance shifting to the individual because of higher deductibles and higher co-payments/co-insurance individuals need to embrace the concepts of evidence based medicine.

Healthcare providers may have skills or bias in either evidence based or patient centered medicine. Of course a healthcare provider may be skilled at both evidence based and patient centered medicine. When choosing a healthcare provider knowing the predisposition regarding evidence based versus patient centered medicine can help guide you whether you should be trusting, skeptical, assertive, or finding another healthcare provider.

As a consumer of health care how do you recognize whether a healthcare provider is providing evidence based medicine and/or patient centered medicine?

Evidence based healthcare practitioner:

• Is likely to cite the evidence, criteria, established protocols and guidelines used to support recommendations
• Will explain why the treatment recommendation differs from the standard
• Is more likely going to answer questions with statistics and percentages
• May discourage you from undergoing a variety of diagnostic tests, and will likely recommend fewer rather than more interventions
• Will likely provided patient education material with references cited
• May appear skeptical rather than certain
• May appear comfortable with ambiguity or uncertainty, and may say I need to do some research on that question; I will get back to you.

Patient centered healthcare practitioner will:

• Not try to persuade you to take action you are not interested in
• Help you identify and clarify the problem
• Ask you questions, seeking to evoke your feelings and emotions
• Ask for your permission
• Affirm your statements
• Help identify appropriate goals
• Recognize and respect your right to disagree
• Advocate for you when there is discord between healthcare team members and health insurance carriers

Bottom line:

• If you sense that your healthcare provider is providing service that is both patient centered and evidence based trust him/her.
• If you sense that your healthcare provider is providing service that is patient centered, and weak on evidence be skeptical.
• If you sense that your healthcare provider is providing service that has a strongly inclined toward evidence and not patient centered be assertive
• If you sense that your healthcare provider is providing service that is neither patient centered nor evidence based find a new provider

It is important when possible that healthcare be a balance between evidence based and patient centered medicine.

Damien Howell Physical Therapy – 804-647-9499 – Fax: 866-879-8591 At-Home, At Office, At Fitness Facility – I come to you, I do home visits Damien@damienhowellpt.com