Thursday, November 10, 2011

Substitutes for evidence based (and science based) medicine

Appearance based medicine Performance measures; looking good on public report cards.  Never proven to help patients, often harmful, generally confused with quality.

Belief based medicine A form of medical decision making driven by the ad hominem fallacy in which one chooses to believe or disbelieve a guideline or scientific paper based on whether the authors have industry ties. Convenient, because no analysis and no scientific or clinical expertise needed.

Coding based medicine Ranks the clinician’s history taking and physical examination skills based on the number of bullet points they generate in the CPT coding system.

Committee based medicine Decisions made by central policy making committees removed from the patient. Promoted by Dartmouth Atlas aficionados. Claims to be evidence based but isn’t.

Consumer based medicine The patient wants it, the patient gets it no matter the evidence. CMS director Donald Berwick once spoke in favor of this type of medicine when he remarked that evidence based medicine may have to take a back seat.

Defense based medicine You know your ER patient doesn’t need that CT, but…

Media based medicine Increasingly utilized by medical thought leaders and policy makers. Why bother to check primary scientific sources when you can read it in the New York Times?

Population based medicine The red pill is cheaper than the blue pill and is just as good. Red pill approved, blue pill denied for all. Often confused with evidence based medicine because evidence based medicine is based on population studies. Not evidence based medicine because it denies consideration of individual patient attributes and clinician expertise.

Template based medicine Driven by pathways and order sets. Accelerated with the advent of the electronic medical record. Often a substitute for thought.