Last week, the industry and public reacted strongly to recommendations from two separate groups to delay the starting ages for mammograms and Pap smears and to reduce their frequency. While the recommendations are non-binding for providers and payors, many say they run contrary to traditional medical wisdom supporting aggressive testing and prevention.
The groups' recommendations were based on a review of evidence and research associated with the screenings. By definition, evidence-based medicine aims to apply the best available evidence gained from the scientific method to medical decision-making, seeking to assess the quality of evidence of the risks and benefits of treatments (including lack of treatment). Evidence-based medicine weighs heavily in healthcare reform proposals. It's built into the patient-centered medical home model, a requirement for wellness and prevention programs and part of how the government wants to define high-value care: the efficient delivery of high quality, evidence-based, patient-centered care." Opponents fear that a reliance on evidence-based medicine will lead to healthcare rationing and controversial "death panels." But most of the time, each provide will have to weigh the value of the science for each patient.
Dr. Richard J. Baron is president and CEO of Greenhouse Internists, a five-doctor practice in Philadelphia that is adopting evidence-based guidelines. Here's what he said during a recent webinar on Evidence-Based Guidelines in the Medical Home:
"There’s a cognitive shift that doctors have to make. Doctors are trained to see patients one at a time and that’s mostly what we do. It’s the way the reimbursement system pays us. We can think about Mrs. Jones who we saw this morning, but you want doctors to shift to think in terms of rate-based data. Not only did I advise a mammogram to Mrs. Jones this morning, but for all the women I saw between the ages of 50 and 65 last year, how many of them had mammograms? And when you start to get doctors to ask questions like that, they become interested in the results, because their first response when they see things they don’t like is, 'It’s not my fault if the patients don’t follow through.'
...Also, we need to recall that the evidence base is a broad population evidence base. If a patient is dying of breast cancer, they probably don’t need to worry about getting a colonoscopy even if it’s due. You need to count on the doctors to critically evaluate the evidence and its relevance to this patient. And then perhaps one of the most important things that the doctors do is they start interacting with their own data."