What Does Evidence Based MEAN?

“If you do NOT have a plan, you are part of someone else’s” – Terrance McKenna

WHAT IS EVIDENCE BASED CARE?

The slide above outlines some very important aspects of patient care mentioning both “PATIENT CENTERED CARE” and “TREATMENT or EVIDENCE CENTERED CARE”.  The issue with these concepts is one puts the patient first (Patient Centered Care) and the other puts the treatment first (Evidence Based Care).  We know that historically treatment centered care (Care Paths) is not always in the patient’s best interest.  These are the pathways that most insurers use which can ultimately pigeon hole a doctor into a predetermined treatment plan, which we have all experienced.  It is understandable that insurers try to manage the patient by a “one size fits all” type of approach while on the other hand we know that every patient presents with a unique situation that must also be taken into account during care, that is the “Patient Centered” side of things.  The last sentence of the slide is the most interesting part, “Patient Centered Care, as does Evidence Based Medicine, considers both the art of generalizations and the science of particulars”.  The generalizations part is related to care path types of treatment where everyone with low back pain, for example, is treated in a similar fashion, while the science of particulars is related to the individuality of the patient’s needs.    

The real issue however is what the term Evidence Based has become…when we look at the next slide, we see that REAL Evidence Based Medicine is made up of three main components, 1:  Individual Clinical Experience, 2:  Best External Evidence and 3: Patient Values and Expectations.  What Evidence Based Medicine has become is related to only ONE of the three, Best External Evidence, which is essentially “peer-reviewed, medically indexed research”.  I have seen over the years it being used as a tool to deny care as opposed to support care.  Carriers will say “there is nothing published” or “it is experimental” , which again is putting all the treatment eggs into the Best External Evidence basket while purposely ignoring the other two!

The slide below goes into more of the details of what each of these areas of Evidence Based Care are and will give you a better idea of their meaning.  #3, Best External Evidence shows you the pathway for research to be published.  It starts with individual case studies, moves to clinical trials and ends really with Continuing Education.  ONE of the biggest issues facing spine care today is the lack of quality CE in a DC/MD environment that focused on the diagnosis and management of biomechanical abnormalities.  You have a VERY unique opportunity to TEACH MDs about chiropractic care!