Evidence based medicine

It can be amusing when people mistake the map for the territory (sometimes called the reification fallacy). When it harms my patients, though, it pisses me off. And it isn’t just me, or my institution: two physician friends (in other states) tell me they are seeing it as well.

It is ironic that evidence-based medicine was introduced, not to eliminate variability, but to ensure that variability was both present and appropriate. 

The scientific method has given us modern medicine, with astounding abilities to diagnose, treat and even cure. Until the last century, medical treatment was futile at best and fatal at worst. Cure was not possible and the touchstone of our profession was comforting the patient. 

Evidence based medicine has much to offer, but one has to remember Einstein’s famous remark: “Not everything that counts can be counted, and not everything that can be counted, counts.”

Before you decide about treatment, you should ask about NNT and NNH. These are numbers that can help you understand how likely the treatment is to help (or harm) you. They are easy to understand - though they can seem confusing to calculate. 

There is a push afoot to use evidence based medicine (EBM) to generate standards of care and then use pay-for-performance  (P4P) to Nudge people towards better behavior.