From 'Cookbook' to Evidence-Based Medicine

Philip Betbeze, March 4, 2011

Once upon a time, physicians, as a group, resisted attempts by private payers and others, to force them to practice safer, more efficient medicine by standardizing patient interventions and the timing of those interventions based on disease states.

Why? Something was lacking. Make that a lot of somethings. The ability to crunch outcomes data from many sites of care was a critical unmet need in previous efforts to standardize care and eliminate duplicative and inefficient medical decisions that cost the health system billions. It was simply impossible to collect this data and draw conclusions from it to recommend changes in care pathways.

At the time, physicians were on solid ground in refusing to follow so-called evidence-based guidelines. They were able to successfully argue that the practice of medicine is largely an art, with wide variations in outcomes more dependent on patients' differences than on their common disease states.

Sometimes, these rules and regulations limited the physician's ability--based on his or her medical education--to treat the patient as he or she saw fit. But most importantly, the evidence for some of the rules was incomplete, flawed, and, they argued, it was being forced upon them by health plans. Some argued that such rules were based more on saving costs than on the improving the welfare of the patient. It was impossible to standardize treatments for patients with certain maladies because each patient reacted differently to the types of care prescribed, they said.

That critical contention was wrong, and now that reams of data from thousands of patients with similar disease states can be sliced and diced, it's becoming evident (no pun intended) that best practices, should they be followed, are better not only for patient outcomes, but for costs as well.

Philip Betbeze

Philip Betbeze is the senior leadership editor at HealthLeaders Media.


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