September 12th, 2011 by PreparedPatient in Health Policy
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How do you calibrate care so that it is neither too much nor too little? In this collection of recent posts, health care professionals search for that “just right” level of care.
“I bet celebrities and other VIPs (as they’re known in hospitals) get some of the worst healthcare in America. And, when I mean worst, I mean the most,” says Jay Parkinson in a recent post. Parkinson explores what is publically known about Apple’s CEO Steve Jobs’ care and calls specific attention to “incidentalomas.” Parkinson describes these asymptomatic tumors, sometimes discovered by especially aggressive care, and suggests that they may be over-treated, leading to poor health outcomes.
Mark W. Browne asks, Is the health quality bar set high enough? Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
April 19th, 2011 by Harriet Hall, M.D. in Opinion
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Before we had EBM (evidence-based medicine) we had another kind of EBM: experience-based medicine. Mark Crislip has said that the three most dangerous words in medicine are “In my experience.” I agree wholeheartedly. On the other hand, it would be a mistake to discount experience entirely. Dynamite is dangerous too, but when handled with proper safety precautions it can be very useful in mining, road-building, and other endeavors.
When I was in med school, the professor would say “In my experience, drug A works better than drug B.” and we would take careful notes, follow his lead, and prescribe drug A unquestioningly. That is no longer acceptable. Today we ask for controlled studies that objectively compare drug A to drug B. That doesn’t mean the professor’s observations were entirely useless: experience, like anecdotes, can draw attention to things that are worth evaluating with the scientific method.
We don’t always have the pertinent scientific studies needed to make a clinical decision. When there is no hard evidence, a clinician’s experience may be all we have to go on. Knowing that a patient with disease X got better following treatment Y is a step above having no knowledge at all about X or Y. A small step, but arguably better than no step at all.
Experience is valuable in other ways. First, there’s the “been there, done that” phenomenon. Older doctors have seen more: they may recognize a diagnosis that less experienced doctors simply have never encountered. My dermatology professor in med school told us about a patient who had stumped him: she had an unusual dermatitis of her hands that was worst on her thumb and index finger. His father, also a doctor, asked her if she had geraniums at home. She did. She had been plucking off the dead leaves and was reacting to a chemical in the leaves. The older doctor had seen it before; his son hadn’t. Read more »
*This blog post was originally published at Science-Based Medicine*
