House Call: Evidence-based medicine keeps doctors, patients open to new therapies

I try to practice evidence-based medicine, something you may or may not have heard of. The term was coined in the early 1990s. As a philosophical concept it has been around since the mid-19th century. A current definition is “the integration of the best available research evidence with clinical expertise and patient values.”

The consideration of patient values was formally added to the definition in the 2000s. That may seem like a small thing, but in reality it is critically important. It reflects an attitude that considers what is and is not important to the patient at the time and for the long haul. It also means that as a patient, you have an active role (and responsibility) in the direction of your health care and its outcomes.

As a physician, I strive to keep up on changes in medicine by attending medical conferences, participating in continuing medical education, using up-to-date medical references and reading professional journals. A major change in the last decade has been the availability of continually updated reference libraries online. The enormous books that I hauled around for years are now mostly obsolete in my daily life.

I combine my clinical expertise and experience with evidence-based practices. For example, we used to treat acute ear infections with antibiotics. Scientific studies now tell us that in children older than age 2 most ear infections will get better without them. However, today I saw a man in his late 20s with a bright red and bulging eardrum. A quick peek at our online reference library supported immediate treatment with oral antibiotics as opposed to “watchful waiting.”

There are a number of organizations that review medical research to determine the best evidence-based approaches. Treatment recommendations are given grades ranging from A (has the best scientific support) to D (not supported by solid evidence and thus not recommended).

Another example of evidence-based changes in practice is in diabetes care. We know that long-term high blood sugar damages your circulation, nerves, kidneys and eyes. So in people who do not have diabetes, the lower the average blood sugar the better. It would stand to reason that the closer we can control and keep a diabetic patient’s blood sugars to normal the better their long-term health should be and that is mostly true. However, in “older” patients we now know from large and focused clinical trials that those older patients benefit from looser control and somewhat higher blood sugars. What we reasoned to be true turned out to be wrong.

When treatment recommendations change like this, you may feel as if the health care community did not know what it was doing before and lose confidence in treatment. Actually, changing treatment recommendations is a good thing. It does not mean that the old recommendations were bad, just that the new ones are even better than before.

As I have mentioned in previous columns, we as physicians sometimes run into health problems that do not yet have available the kind of rigorous scientific research we would like to have to inform our treatment decisions. In those cases we use the best science that is available, combine it with our experience and the opinion of experts, and then do the best we can, trying our hardest to “first, do no harm.”

Today’s proponents of evidence-based medicine are working to increase the amount and quality of evidence available. They are also working to make it easier for doctors like me to find and digest that information so that I can provide each and every patient with the best care possible.

You can learn more about evidence-based medicine by watching this 45-minute video (http://ebm.jamanetwork.com/).

Dr. Bob Riggs is a family medicine physician practicing at Group Health’s Riverfront Medical Center.