Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Evidence based medicine removes a physician’s autonomy

Angry Orthopod, MD
Policy
October 24, 2011
Share
Tweet
Share

Evidence based medicine.

Just think about it for a second. This means now we actually practice medicine based on bona fide evidence? What the hell have I been doing for the past 25 years? Making it all up? And who wrote those thousands of articles I’ve read? Dr. Seuss?

Evidence based medicine, or EBM, may be just another way to remove a physician’s autonomy. This trend has marched on for years, castrating us bit by bit. EBM is nothing more than the old process of peer-reviewed journal articles, but now there’s a classification systems that grades according to the article’s strengths or weaknesses. In other words, it’s to help the non-academic dummies tell the difference between crap and quality. In the U.S., a five-level scale is favored, while the U.K. prefers a four-stage system, and there are others.

My interest in this is truly for the end recipient: you, the patient. I think EBM at its core is a good thing, but its ultimate use must be questioned. The obvious objective for EBM is to arrive at the best care for the patient with a certain diagnosis. The subversive goal of EBM is to “mechanize” the whole medical delivery system and put the decision-making process on a prescribed pick list.

Forever, medical practitioners have enjoyed the latitude that allows them to treat patients on an individual basis. This is otherwise known as the “practice of medicine.” It employs experience, collegial interaction, and a reasonable knowledge of the appropriate literature to date.

This is where it gets weird. EBM is the current “buzz word” from med students to practicing physicians to researchers. Professionals speak of it like some new Holy Grail of medical research. In fact, it’s cool to be overheard uttering the words “evidence based medicine.”

Let’s just call it a sort of medical merchandizing. EBM is nothing different than all the scholarly literature that has preceded it for over 100 years repackaged as new and improved.

Of course the randomized, triple-blinded, placebo-controlled study is the research crown jewel, but those studies are far and few between, especially in our paranoid, liability-fearing world. Who decides the assignment of a level? Does a higher-level study render all lower ones irrelevant by default? Can’t I decide which articles are accurate and relevant, to me?

Now I’m certain my orthopaedic colleagues would never openly admit to what I am about to say even though they know it is true. Not to brag, but I knew what articles, chapters, and books were good and which were crap years ago. I still do. Experience and education leave me with the ability to accurately sort through this stuff and determine good from bad. I know just about everyone writing this stuff in my field, therefore I know who is and isn’t relevant. I’m not implying even one author is lying. It’s just that some write dribble rhetoric and some put out timely, novel, and useful work.

Most everyone thinks of this EBM stuff as all good. Doctors do, third party payers do, and let’s not forget Uncle Sam. Doctors, the ultimate holders of the key to patient care, are being lead to slaughter in years to come, and EBM is part of the puzzle. The health insurance companies love it as they can soon declare sweeping changes to save money in the name of “best practice” criteria. Finally, the government would like nothing better that to control the practice of medicine just like the military. Look how well our Veterans Administration system works.

While protocol can be good for medicine, policy is not.

If allowed, EBM will change medicine from a practice of individual-based, case-by-case care to cookie-cutter cookbook recipes. Maybe some docs need a cookbook but I don’t. The docs I respect don’t either.

“Angry Orthopod” is an orthopedic surgeon who blogs at his self-titled site, The Angry Orthopod.

Submit a guest post and be heard on social media’s leading physician voice.

ADVERTISEMENT

Prev

How new doctors will kill private practice

October 24, 2011 Kevin 28
…
Next

An adult relationship with my patients

October 25, 2011 Kevin 5
…

Tagged as: Public Health & Policy, Specialist, Surgery

Post navigation

< Previous Post
How new doctors will kill private practice
Next Post >
An adult relationship with my patients

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Angry Orthopod, MD

  • a desk with keyboard and ipad with the kevinmd logo

    A good doctor should rarely be surprised by test results

    Angry Orthopod, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Why physicians are clueless about malpractice implications of DVTs

    Angry Orthopod, MD
  • a desk with keyboard and ipad with the kevinmd logo

    MRI overuse is widespread, and dangerous to patients

    Angry Orthopod, MD

More in Policy

  • Why physician voices matter in the fight against anti-LGBTQ+ laws

    BJ Ferguson
  • The silent toll of ICE raids on U.S. patient care

    Carlin Lockwood
  • What Adam Smith would say about America’s for-profit health care

    M. Bennet Broner, PhD
  • The lab behind the lens: Equity begins with diagnosis

    Michael Misialek, MD
  • Conflicts of interest are eroding trust in U.S. health agencies

    Martha Rosenberg
  • When America sneezes, the world catches a cold: Trump’s freeze on HIV/AIDS funding

    Koketso Masenya
  • Most Popular

  • Past Week

    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Closing the gap in respiratory care: How robotics can expand access in underserved communities

      Evgeny Ignatov, MD, RRT | Tech
    • Reclaiming trust in online health advice [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Why so many physicians struggle to feel proud—even when they should

      Jessie Mahoney, MD | Physician
    • If I had to choose: Choosing the patient over the protocol

      Patrick Hudson, MD | Physician
    • How a TV drama exposed the hidden grief of doctors

      Lauren Weintraub, MD | Physician
    • Why adults need to rediscover the power of play

      Anthony Fleg, MD | Physician
    • How collaboration across medical disciplines and patient advocacy cured a rare disease [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 21 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Closing the gap in respiratory care: How robotics can expand access in underserved communities

      Evgeny Ignatov, MD, RRT | Tech
    • Reclaiming trust in online health advice [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Why so many physicians struggle to feel proud—even when they should

      Jessie Mahoney, MD | Physician
    • If I had to choose: Choosing the patient over the protocol

      Patrick Hudson, MD | Physician
    • How a TV drama exposed the hidden grief of doctors

      Lauren Weintraub, MD | Physician
    • Why adults need to rediscover the power of play

      Anthony Fleg, MD | Physician
    • How collaboration across medical disciplines and patient advocacy cured a rare disease [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Evidence based medicine removes a physician’s autonomy
21 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...