Regardless of what branch of health care we practice, all health care professionals need to and generally want to document whether the proposed therapy they are offering a patient is actually effective.
Most of us have had several years of formal training, academics and clinical internship to practice in our field. The question is, what are we documenting: their symptoms, their physical or mental function, their limitations, or their quality of life?
Hopefully, we are looking at all the above.
Evidenced-Based Practice: What Does it Mean?
In the last few decades, the term evidence-based practice has become very popular in healthcare circles. Evidence-based practice is “based on information gathered by a systematic and critical review of published literature.
Evidence-based practice promotes decision-making that reflects best-available information, rather than clinical experience and perceptions of therapeutic efficacy, which can be inaccurate.” This strict definition has been debated since it first came out. Although at first glance this may seem reasonable, the problem with sticking to this rigorous definition is that it throws out the baby with the bathwater. There is no room for very real factors such as practitioner experience or patient influence in managing a particular healthcare procedure. Some extreme views hold that any profession not following strict evidence-based practice is tantamount to quackery.
Are Best Practices Really Best?
To answer this issue, a more nuanced approach called best practices has gained momentum. Best practices “entails making decisions about how to promote health and provide care by integrating the best available evidence with the practitioner’s expertise and other resources, and with the characteristics, state, needs, values and preferences of those who will be affected”, i.e., the patient. A few years back, I did a write up on the placebo effect and its very real and significant influence on positive patient outcomes. Nothing promotes a better placebo effect than when a patient experiences health care from a confident, skilled, and seasoned healthcare professional. However, that is something very difficult to research in a clinical setting.
How We Track Care
In my office, I find that asking questions, specifically asking the right questions, is the best approach. What are your concerns? How does it affect your daily life? What would it mean to you if we could help you? What are you trying to achieve by coming to us? With this information and a clinical exam we are ready to recommend a plan of action that includes regular progress exams. On those follow-up exams, we ask new questions. What has changed in your life since you started care? Do you find the care you receive at our office of value? If so, why, if not, why not? To what extent have we been able to help you achieve your health goals?
The Importance of Research
Scientific research is important and all health practitioners owe it to themselves, their profession, and most importantly to their patients to stay on top of new information in their field. Ultimately though, in my experience, patients don’t really care as much about what you do, how you do it, what you call it or how many scientific studies there are on your techniques to help them. They will stay as long as it is safe and improves the quality of their lives. If not, they will quickly move on to someone else.