“Jaded Julie, how would you feel if you were diagnosed with a serious illness?”
“I’d feel very much alone, Curmudge. Your family and friends can give you food, shelter and care, and they can even assume your debts. But no matter how much people love you, no one can be sick for you.”
“So what would you do?”
“I would have a choice. If I chose to be a totally passive patient, I could take the prescribed medicine, suffer its side effects, and hope and pray for the best. The other option—and that’s what I would select—is to become an expert on my disease and an active participant in my health care team. That way I could take full advantage of personalized care and maybe even help to cure my illness. Hey, the game of life vs. death is one that you can only lose once.”
“Sounds like a plan, Julie. How would you proceed?”
“Well, if I lived near a hospital with a library, like St. E’s or Mercy Medical Center, I’d seek the librarian’s help in learning all I could about my situation. But tell me, Curmudge, what should I do if a city is not nearby or if I were reluctant to share the details of my health with a librarian?”
”In the privacy of your home office, you or a relative or friend should use your computer to google your disease. That will open up a world of medical knowledge.”
“But I don’t want the world. I just want some stuff that I can comprehend.”
“There’s something for everyone out there, Julie, including a lot of sources that one can understand without an MD degree. Your Google search will provide a list of titles followed by a couple of lines describing the contents followed by the URL. Note, however, that the pages of your Google search results will show so-called Sponsored Links; some of these may contain testimonials and ads for non-FDA-approved treatments. Below are a few URLs that should be helpful; they will usually provide an overview of symptoms, diagnosis, and treatment in everyday language.
Mayo Clinic (www.mayoclinic.com)
MedLine Plus (www.nlm.nih.gov/medlineplus)
Merck Manuals (www.merck.com)
Wikipedia (en.wikipedia.org).”
“This sounds pretty useful, Curmudge, but where does evidence-based medicine enter the picture? It’s in our title, but you haven’t mentioned it once.”
“The sites mentioned above contain review articles written, for the most part, in everyday language. Procedures for diagnosis and treatment are evidence based as understood at the time of writing. To learn about new knowledge developed since then we’ll have to look into other—and often more technical—resources. We’ll also have to come back for more discussion next week.”
“So that I don’t go away empty-handed, can you give me a definition of evidence-based medicine?"
“Of course, Julie. Evidence-based medicine is the generally accepted best procedure for the diagnosis or treatment of a specific illness or condition. ‘It requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report (1).’”
“Thanks bunches, Curmudge. It will take me all week to figure out what you just said. But I do understand that I would want to receive the best care available. Presumably that will be evidence based unless my physician and I agree on a good reason to do otherwise.”
Affinity’s Kaizen Curmudgeon
(1) Agrawal, P. and Brown, C. A. An evidence-based approach to acetaminophen overdose. EBMedicine.net, September 2010.
Note: An observation on the practice of emergency medicine in a primitive location may be accessed via this link.
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