Evidence-based practice for best outcome
By Leonardo L. Leonidas
Philippine Daily Inquirer
October 13, 2013 at 9:15 pm

Ideally, all physicians should use evidence-based practice to get the best outcome, or less complications, for the prescriptions they give or procedures they administer, or not.

The first physician to introduce the concept was Dr. David Sackett, a Canadian, who defined it as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” It means “integrating individual clinical expertise with the best available external clinical evidence from systematic research,” he added.

Evidence-based practice basically involves assessing the patient, asking correct questions, acquiring and appraising the evidence, and then applying it for treatment of the patient. The physician’s evaluation of his/her performance with the patient is the concluding stage of the process.

But while the ideal is the universal use of evidence-based practice, in reality not even the majority of physicians are into it, for a number of reasons.

One reason is their age. If they graduated from medical school more than 25 years ago, I think they are generally less likely to go into evidence-based practice. The concept is, after all, only about 20 years old. When they were in medical school or in a hospital for their training program, evidence-based practice was not yet in the consciousness of their mentors.

Not all medical practitioners have the financial resources to attend international or national medical conferences. They cannot afford the expenses of travel, hotel accommodations and registration, or of the latest textbooks, and the loss of income from such activities.

Another reason even for recent medical graduates is it takes time to do research for a patient. Their time may be consumed by the many patients they tend to, and besides, medical insurance does not pay for research. Physicians are paid only for their patients’ face-to-face office or hospital visits. Probably only a few conscientious physicians will go out of their way to “burn the midnight oil” and study the difficult problem of one or two patients without compensation.

And unfortunately, many physicians are still in the 20th century in terms of office management. They have no desktops, laptops, iPads, or tablets. Or they have no time to learn how to surf the Internet, open an e-mail, or log on to Facebook or Twitter. A few of them may have a technology phobia, like the fear of flying.

At this time, there is no way for patients to know who are the physicians administering evidence-based treatment and recommendations. Certification for this mental activity is impossible to do. Most patients choose their physician on the basis of a relative’s or friend’s recommendation, or experience. Some are referred by their personal physician to another for a second opinion. Others just consult the phone directory, or the advertisements in the media. One of my friends found the name of a pulmonologist, or a lung specialist, on the hallway wall of a hospital.

Now that many patients have access to the Internet through various gadgets, they can do their own evidence-based research in the comfort of their homes, workplaces, schools, hospitals, doctor’s offices, etc. As a result, medical care will dramatically improve.

Here are some tips on how to determine if the website you are visiting is trustworthy. If the URL address of the website ends in .gov, .edu, or .org, it is usually reliable. The website that professionals go to is pubmed.com, which you can also visit for free. However, you need a medical dictionary and some knowledge of statistics to understand the reports in this website. But don’t be intimidated by the medical terminology or complex numbers. The conclusion of each abstract is usually easy to understand.

Some of the top health websites that I recommend are: MedlinePlus (http://medlineplus.gov/), NIH SeniorHealth (http://nihseniorhealth.gov/), Centers for Disease Control and Prevention (http://www.cdc.gov/), familydoctor.org (http://familydoctor.org/), healthfinder® (http://www.healthfinder.gov/), Kidshealth® (http://www.kidshealth.org/), MayoClinic (http://www.mayoclinic.com/), NetWellness (http://www.netwellness.org/), and Cancer.gov (http://www.cancer.gov/).

You can also determine the reliability of a website when the writers or speakers in its videos are experts in their field. Health websites should have minimum ads, or none at all. Websites peppered with ads should be avoided.

Look for websites that are regularly updated and whose privacy policy is easy to find and understand. The need for just-in-time information is extremely important because new information from research is reported or updated monthly. The date of publication and latest revision should be clearly stated and easily found. This is usually at the end of the article or page.

The best health website contains reports that are written clearly in simple language that even tenth graders can understand. It should carry facts, and not opinions, that can be verified or supported by other researchers or experts in the field. A website with the HONCode logo is generally reliable. If you have no time to surf sites, MedlinePlus (http://medlineplus.gov/) has both English and Spanish versions that can answer most common questions.

Dr. Leonardo L. Leonidas ([email protected] gmail.com) retired in 2008 as assistant clinical professor in pediatrics from Boston’s Tufts University School of Medicine, where he was recognized with a Distinguished Career Teaching Award in 2009. He is a 1968 graduate of the University of the Philippines College of Medicine and now spends some of his time in the province of Aklan.

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