TUCSON, Ariz., Sept. 8, 2016 /PRNewswire-USNewswire/ -- The patient-physician relationship is largely being replaced by expert protocols and "best practices," writes Hermann W. Børg, M.D. in the fall issue of the Journal of American Physicians and Surgeons. Although these may be called "guidelines," the physician may be required to justify any "deviation." The guidelines are created with and justified by "evidence-based medicine" (EBM), Dr. Børg explains.
EBM is a response to challenges in 21st century medicine, including information overload, calls for cost containment, and the change from a cottage industry to a managed industrial complex, Dr. Børg states. Also, respect for physicians has been replaced by distrust and unlimited demands.
EBM must first define what constitutes evidence. There is a graded hierarchy, with costly controlled trials at the top and physicians' observations at the bottom. Yet Dr. Børg notes that observations made at close range, often dismissed as "anecdotes," can be invaluable. Moreover, the paucity or absence of "anecdotes" that are consistent with the accepted theory may prompt a reexamination of the theory. Often theories are developed from trials in a limited population sample, based on over-simplification of complex biologic phenomena.
Numerous problems with EBM are emerging and being discussed in major medical journals. These include:
- Distortion of the EBM approach by vested interests (pharmaceutical industry, payers and administrators);
- Focusing on marginal changes in risk factors rather than actual disease states;
- Over-emphasis on following algorithmic rules instead of sound clinical judgment;
- Trying to impose a poorly fitting theory on patients with multiple problems; and
- Disregard for genetic differences between patients.
"Strict application of EBM implies a mechanistic algorithm-driven approach, similar to primitive pre-artificial-intelligence computer programs of the past. In such an approach, the doctor sees the patient as a statistic rather than an individual. This sort of medicine could be practiced by administrators," Dr. Børg writes.
However, EBM flaws are becoming so obvious that "even its past ardent promoters are willing to admit that this movement is in crisis," Dr. Børg states.
"Ironically, advances in scientific knowledge are showing the importance of the focus on the individual," he concludes.
The Journal of American Physicians and Surgeons is published by the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties since 1943.
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SOURCE Association of American Physicians and Surgeons (AAPS)