I have been thinking hard about what to write about for this blog given that it is the first one I am writing on behalf of our brand-new clinic. I have chosen to write about what in medicine we call "Evidence-Based Practice". Bear with me, please!
Briefly, this means that a combination of an "expert" (hopefully me!), the best possible information and resources available (science), and patient “values” (your preferences) result in the best management recommendations for you as the patient. If only it were this easy.
Many other factors influence management decisions; commercial pressures, professional pride, and patient demands for what they perceive as the "best treatment". It is like the recent situation faced by the country during the national elections. All political parties know there is no money for services, but politicians want to win, and telling the truth may be too risky for their electoral aspirations.
Similarly, medical professionals want to become successful. They want to be seen by patients as offering the latest technology and treatments because if they do not, patients may vote with their feet and seek help elsewhere, even if these technologies may be unproven or unnecessary. Allow me to share one example to illustrate my point.
Recently, I received a letter from a patient requesting for the operation to be done under robotic surgery. Having read the ads about robotic surgery, this person was convinced that the operation would be better for them. I explained that we did not have access to robotics, that this would require referral to a hospital that does have robotics, and that this would inevitably mean prolonging their wait. I also explained that their case may not necessarily benefit from robotics as the scientific evidence has not shown a difference in patient outcomes. What I said is based on studies such as the 2023 study published in the Journal of Bone and Joint Surgery (Bone Joint J 2023;105-B(9):961–970.) which stated that, overall, the use of robotics did not provide any benefits in function, quality of life, and satisfaction compared to the conventional operation. I am not saying that robotics will turn out to be a huge waste of money, only that at present, there is no hard evidence that it makes a difference to all patients. The patient insisted, so I made the referral.
Should I have been more forceful in my explanation that waiting for up to another two years was irrational especially when it would probably not make a difference in outcome? How far should I as a surgeon go in trying to persuade a patient that the evidence does not support what they are asking for?
Competing forces try to mislead us into adopting a certain course of action that is not necessarily in our best interest. As doctors, I feel that we must thoroughly explain what the best available evidence is to our patients, but that is as far as we can go. As I usually tell my patients, "You are the boss".
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