Health Care Thoughts: Evidence-based medicine not easy
by Tom aka Rusty Rustbelt
Health Care Thoughts: Breast Cancer Battle
Evidence-based medicine may not be as easy as it first sounds.
An opinion piece in the British Medical Journal (http://www.bmj.com/content/345/bmj.e5132) attacks the Susan G. Komen Foundation for over-hyping the value of mammography.
This is not a new controversy, and experts have lined up on both sides of the argument.
There is general agreement that screening has value, but a great deal of disagreement about who, when, how often, the measurable benefits and the potential negative impacts. The current battle is over the mortality statistics and whether mammograms are being oversold.
False positives certainly lead to unneeded biopsies, but unneeded biopsies do provide relief from emotional issues. There is often value in early treatment, but are we over testing?
For now, women should consult their own physician and consider family history. When in doubt seek a second opinion from a major medical center with breast cancer specialists.
The debate will rage on.
I should have mentioned that evidence based medicine is a major emphasis of PPACA (Obamacare), Obama is counting on EBM to bend the cost curve.
False positives are a major problem with any screening proposals.
The biggest problem I see with EBM, is the implimentation has been as a cook book process. It has actually worked to relieve the doctor from having to think and apply their knowledge. They all know the game now, what to say was found in the exam, how many weeks to wait, what string of proceedures to do to get to that golden egg.
There is no real doctoring going on, that is the application of the doctor’s knowledge to the particular person standing infront of them. It is why NP’s are working out so well in the PCP’s office. Just follow the cook book.
Using so-called “evidence-based medicine” (EBM) to treat patients can also be very costly, Rusty. For instance, Blue Cross Blue Shield (BCBS) has decided not to reimburse hospital providers in my area if they can’t keep the glucose levels of their diabetic patients within the rather tight range of 70 and 160. In order to do this, my hospital, for example, has had to hire a full-time endocrinologist, three full-time nurse practitioners and four full-time RNs just to manage the glucose levels of our diabetic patients. This doesn’t include all of the extra work that the bedside nurses have to do to monitor, chart and care for these patients. Very costly, indeed!
And because my hospital and other hospitals in the area are being required to use EBM to do this, all of our diabetic patients are required to be put on the same type of insulin, regardless of the type of insulin they were using at home. Evidently, the EBM community is totally clueless to be fact that it can sometimes take a while — much longer than the average hospital stay, no doubt — for a patient’s body to adjust to a new form of insulin.
Consequently, putting diabetics on an EMB glycemic protocol in a hospital setting often times results in their glucose levels being more labile, more erratic, than they normally would. At any rate, I’m pretty much convinced that insurers like BCBS don’t care whether their policy holders with diabetes have well controlled glucose levels or not, they are only interested in coming up with more creative and convoluted ways to deny reimbursements to hospitals.
My wife (aka the world’s greatest nurse) came home from work at 1:00am absolutely boiling about related issues.
I am going to write a post entitled:
“Re-admissions, resident rights, and Pie”
A whole post Rusty? Finally…may Mrs. Rusty spur you on.
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Treatment for breast cancer include surgery, drugs hormonal therapy and chemotherapy, radiation and immunotherapy. Surgical removal of the tumor provides the single largest benefit, with surgery alone curing many cases. Thanks.
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