What is evidence based medicine?

This could be answered on two levels. Mind you our answers, being those of workers’ compensation lawyers, may not be the answers which doctors would give you.

The first level, that of medical journals and the like, evidence based medicine is an attempt to make medicine more of a system using the “current best evidence in making decisions about the care of individual patients.” On the second level, the level of evidence based medicine as it seems to be practiced by doctors who speak at Industrial Commission conferences and treat a lot of injured workers is to put great emphasis on all the scientific aspects of the examination and significantly less emphasis on what a patient is telling them. At least that is what is reported to us by many patients.

What it comes down to is that a lot of injured workers are really lousy at explaining how they got hurt and where precisely they hurt and what makes the pain increase or decrease. Accordingly, their complaints have little value in terms of science. On the other hand physical examinations and tests like x-rays, CT scans, and MRIs are accorded great scientific value.

A doctor may discount what you are telling him if he cannot confirm it scientifically. That sort of stinks if your adjuster won’t authorize the MRI, which would provide that confirmation. In terms of putting evidence based medicine into practice for treatment options a doctor may emphasize the statistical results of other patients around the world and less on the potential benefit in a given patient. The problem with all this is that if your body doesn’t respond to a course of treatment like 95% of the rest of the world does it doesn’t make you a liar. It means you’re an exception. Exceptions are known to exist. It’s unfair to dismiss a patient just because they are an exception.

In a perfect world evidence based medicine sounds like a great idea. In the real world of competing interests and power struggles we’ve seen it misused and sometimes does nothing other than providing a fancy name for an excuse to not pay attention to you.