MSM post #001

Evidence Based Medicine

“Humans are allergic to change. They love to say, “We’ve always done it this way.” I try to fight that. That’s why I have a clock on my wall that runs counter-clockwise.”

-Rear Admiral Grace Hopper- Naval Officer, Computer Scientist

One of the most dangerous expressions in medicine is “We’ve always done it this way” or, a variant “This is just how it’s done.” There is an old expression that is attributed to Fire Services that they express “one hundred years of tradition, uninhibited by progress.” This paradigm pervades medicine and it is time for a change.

For decades, academia and medical education have relied on what is published in textbooks and pre-written lectures based on outdated information. When a student enters a classroom, the textbook they receive (and often pay for in addition to the cost of the class) contains lessons and data that may be more than five years old. The students will then sit in a classroom for anywhere from three months to four years receiving information that will do them and their patients no good when they leave the classroom. Surely we can do better.

Often when students leave the classroom, even if they’ve received training from the most bleeding edge progressive program, they are sent to their respective organization that depends on a hierarchy of individuals who demand that their word not be questioned. This is the basis of the failed paradigm of eminence-based medicine. We have cultivated a society where EMTs often have to answer to their captain or line officer, paramedics must obey their senior medic, and new residents must perform tasks that their supervising attending has been doing for years. This is not to discount the value of experience, as surely there are aspects of healthcare that only experience can teach. It is simply a suggestion that the model of “I’ve been doing this longer than you, so I know best” is a failed model.

Evidence-based medicine, on the other hand is slowly becoming the standard in some facilities and within progressive organizations. These forward-thinking organizations will take the time to analyze the available data and change their practice based upon what the evidence shows. These practices have significantly changed how medicine is practiced in the emergent setting. For decades we knew that backboards fully immobilize people. We were wrong. We knew that ALS interventions in cardiac arrest improve outcomes and save lives. We were wrong. We knew that if a patient presented with a lower-than-I’m-comfortable-with SPO2 that the only treatment was more oxygen. We were wrong.

Evidence-based medicine is the future of medicine across all specialties. Projects that adhere to the evolving patient-care standard that is supported by a plurality of available evidence will be the projects that affect the most change in healthcare, and improve the most patient outcomes. These are the projects were should look up to and strive to emulate. Projects that do not subscribe to evidence-based standards should be brave enough to shun the norms that their culture has grown to accept, and have the tenacity to do what is right for their patients.

Change is never easy, and adaptation can be a long, involved process. But these processes are necessary to provide the best care we can for our patients. They deserve it.