April 01, 2013
2 min read

Enhance patient needs, clinical experience with evidence-based practice

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Consider three common scenarios. A 69-year-old, pressured by changes in his health insurance prescription plan, inquires whether a generic will work as well as his branded glaucoma medication. A 37-year-old accountant experiences mid-afternoon ocular dryness and fatigue, causing her to wonder whether a different type of contact lens will work better. A 58-year-old whose mother has age-related macular degeneration asks whether she should be taking an eye vitamin for prophylaxis.

They are three very different problems but they share a commonality – and it is the very reason patients seek our services every day. They come not necessarily for a glaucoma prescription or a trial pair of contact lenses or even an over-the-counter recommendation. They come for our expertise and advice. While this is both gratifying and heartwarming, providing patient recommendations is also a huge responsibility and one that can never be taken lightly.

While our patients – and their needs – are always first and foremost, meeting those needs can be a balancing act at times. On one hand we pride ourselves in getting to know our patients and tailoring each recommendation to mesh with an individual’s personality and preferences. On the other hand, we value what many years of clinical practice has taught us and strive to incorporate our experience into patient care in a meaningful way. While both are important considerations in making patient care decisions, they are somewhat subjective and emotional in nature. In short, they are decision drivers that are not necessarily based on scientific methodology or rigorous peer review or derived from extensive clinical trials. In other words, they are not necessarily evidenced-based decisions.

Michael D. DePaolis, OD, FAAO 

Michael DePaolis

Evidence-based medicine – or evidence-based practice in a broader sense – continues to alter the landscape of virtually all health care disciplines. It is a concept that has been embraced by academic institutions, professional associations, insurers and government agencies alike, and for good reason, as evidence-based practice interjects an element of scientific scrutiny into every clinician’s decision making. It requires us to look at clinical trials and related literature in such a way as to more closely analyze the methodology, statistical analysis, conclusions and clinical relevance to a specific patient’s care.

The ultimate goal of evidence-based practice is to get clinicians to rethink the way in which they make decisions, lean more heavily on scientific evidence and – it is hoped – provide better care. The question, of course, is whether evidence-based medicine is too rigid and impersonalized, especially given that all of us care for individual patients who are statistical “outliers.”

In reality, evidence-based practice is not necessarily meant to replace individual patient considerations and practitioner experience. As stated by David Sackett, MD, and colleagues: “The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice.”

Simply put, the goal of evidence-based practice it to employ clinical trial results and scientific literature in a way that enhances individual patient needs and clinician experience, resulting in even better patient care outcomes. After all, is that not what we want for every patient?

Sackett DL, et al. Evidence-based medicine: What it is and what it isn’t. BMJ. 1996;312:71-72.