Evidence Based Medicine

 

Hi, everybody. This is Mike Staver. This is Mondays with Mike, a weekly video series, where we answer questions from people just like you. Here’s this week’s question. Boy, it’s a medicine question.

“Evidence-based medicine tries to reduce variations in practice, reduce inappropriate care and reduce waste by using results of studies of large groups of people as the basis for medical guidelines. On the other hand, some people feel that it is bad medical policy to apply general rules to all cases and that medicine requires the physician use his or her knowledge of the particular patient in deciding on the course of treatment along with the patient. What do you think?”

What? Do you understand any of that question or–?

Johnny: Vaguely.

Mike: What are they saying? Are they saying, do I think it should be evidence-based or individual? I think that’s what it’s saying, isn’t it?

Johnny: Yes, do we apply general swath rules, from textbooks or do we go by a case-by-case basis? I think it goes back to dichotomy again, of like, it doesn’t have to be an either-or situation.

Mike: Wow. That’s a deep question, right there, isn’t it?

Marty: Yes, truly.

Mike: Don’t you think? Here’s what I think. Being a patient right now of the amazing Mayo clinic, Dr. Kruger’s my surgeon, he’s amazing, Laura is my hand therapist, she’s amazing. The other day, Laura couldn’t work on my hand. I haven’t worked on it every week and Laura couldn’t work on my wrist, so there was another person there. Her name’s Cece, she’s an amazing hand therapist in Mayo Clinic in Scottsdale. Really good. It’s interesting that you would send this question. Maybe they send it. I don’t know, but she said there is a large movement now to move to individual case-based medicine.

Let me give you an example that my doctor and both my therapists have given me. This hand, right now, this wrist has limited range of motion, I had surgery back in January, as limited range of motion, but the range of motion is in what they called the functional range, which means the wrist is usable. They all said to me or I said to them, I said, “What is functional is not necessarily functioning,” because this amount of- this is called flexion, this amount of flexion still is uncomfortable. If I have to wash my face or wash my shoulder, whatever, it’s still uncomfortable.

I’m not a physician. Let me chat about the leadership world. In the leadership world, I always say, “You lead individuals.” You might have a team and you might plant the flag on the hill for the team, but you always adapt your leader behavior to what the individuals need. Medicine should be the same way. Now, I know there’s big swaths of research. I know that even if we look at the vaccine right now, they did big group research and they’re going to apply it. They know the side effects.

What I’m talking about is, if I’m going to the doctor, I want the doctor to pay attention to me. I don’t want four out of five dentists surveyed recommend sugarless gum to their patients, a chew gum. I want them to look at my teeth and say, “Gum’s not for you.” I want my doctor to say, “Here’s your specific case.” I’m a big fan of evidence-based individual treatment. I don’t want to miss go, “Let’s give it a shot with you.” I want an evidence-based, but I think individualized treatments are very important.

That’s why choosing a physician and a treatment team and the people that are working with you is very important that they know you, not just know your case. Hope that’s helpful.

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