Do you practice evidence-based Medicine? or you feel you were put in a situation where patient best interest is not being looked at as first priority. But rather as revenue generating for job security especially in the employed physician category!
To put it all in prospective, here are real examples to illustrate this challenge. A 58 year old female patient with persistent dry cough , a tickle in the throat who has seen multiple consultants including Ear, Nose and Throat specialist, then allergy specialist, then a Gastroenterologist ( stomach doctor) who saw patient and performed upper Endoscopy and gave patient anti-reflux medication, but cough continued and a fourth consultant was added being a lung doctor , He did work up including CT scan of the chest which was negative and so was the multiple allergy testing done was negative.
Then I saw the patient and went over carefully her medication list that she was currently taking and Bingo , it was clear that these symptoms were obviously due to side effects of one of the medications she was taking causing her dry cough and tickle in the throat symptoms . This medication belonged to a class of drugs called ACEI , or Angiotensin -Converting Enzyme Inhibitors which after being switched to a different class of medications called ARB or Angiotensin Receptor Blockers that does the same therapeutic benefit without the side effects. Wow, the patient after the switch of medications, dry cough ,throat irritation and the need to clear her throat every couple of minutes miraculously gone! Only, if this was done earlier , could have saved tens of thousands of dollars of unnecessary healthcare money and procedures and achieving better outcome for only few dollars spent instead!
The same can be seen in cholesterol lowering therapy that prevents progression of atherosclerotic plaques or hardening and clogging of the arteries which if left untreated will certainly lead to subsequent clinical events such as Angina or chest pain first on exertion and if left untreated will lead to Unstable angina and acute heart attacks , strokes and peripheral vascular disease leading to gangrene and amputation . That is why we all should address these issues seriously and aim to achieve target numbers for cholesterol and triglyceride lowering by diet, exercise, life style modification with smoking cessation,limit alcohol intake and medications to prevent close to 80% of cardiovascular morbidity and mortality affecting millions of Americans and costing billions of dollars.
86% of every healthcare dollar spent goes to chronic disease management which is largely preventable and achievable on outpatient ambulatory basis with empowering patient through education and advocacy.
The fast changes dynamics of healthcare will dictate the adoption of evidence -based Medicine for cost saving while improving outcome. Similar examples including unnecessary IV therapy including vitamins such as B12 and others , iron, fluids, antibiotics ..etc which can be given orally effectively unless than patient has a malabsorption syndrome and can not hold anything down due to uncontrolled vomiting or diarrhea which is the only justifiable indication then. This will help patient to avoid unnecessary complications such as IV site infection with the risk of introducing Staph infection into the blood stream especially in cases where patient has hardware like pacemakers, defibrillators , artificial heart valves, or joints. This risk increases with every time the integrity of the skin is compromised with needle and catheter insertion plus the so many trips that patient make with some of whom are elderly, frail and can not drive . Adding enormous stress on patients making these trips to justify billing the third parties for these services. And in many cases, the patients are stuck with the bill for unnecessary IV therapy or its complications putting additional stress on the already stressed patient. Believe me, those patients tell me their unfortunate stories.
In brief, patients are fed up with the non sense and they need and appreciate their honest doctor who will tell the truth and support them no matter what!