EBM and AMI
So I have been reading about evidence based medicine (EBM) recently and I ran across this article today. According to a study published in JAMA, a number of "accepted" clinical guidelines for treating acute myocardial infarction (AMI) are actually weakly correlated with improved outcomes. That should throw up a red flag for providers. So what do you do with those guidelines? Throw them out the window? If you are committed to following EBM, then perhaps.
A key principle of EBM, and this appeals to scientifically-minded physicians, is that you employ interventions that have evidence to support their effectiveness. This sounds logical enough. After all, what are all those medical journals for anyways. But this isn't necessarily how many physicians practice, with all due respect. A great physician speaker once defined for me another, quite prevalent theory of medicine: eminence-based medicine, or making the same mistakes with increasing confidence over an impressive number of years. As I have always said, physicians are humans too and old habits are hard to break.
Now it certainly isn't just physicians that are to blame. Most of us in the healthcare industry have jumped on the quality measurement and reporting bandwagon. In doing so, we typically accept that the measurements or protocols foisted upon us are "good medicine" (certainly as a non-clinician, I leaned on the experts for best-practice). Nonetheless, we all need to remember to keep the tenants of good science and EBM in mind as we serve the master of performance improvement initiatives. Our other master, the best outcome for the patient, deserves nothing less.