February 17, 2022
3 min read
February 17, 2022
3 min read
Romeo reports receiving royalties from, being on the speakers bureau and a consultant for, and doing contracted research for Arthrex.
The fundamental relationship of caring for patients can often be overshadowed by the increasing influence of the business of health care.
Leadership may forget that physicians are not machines who can be “tuned up” to see one more patient per hour or replaced with providers who offer basic care at lower costs and acceptable risks.
At some point in our lives, we decided serving others was our lifetime vocation. Service to patients begins with listening to their reasons for seeking care. It is followed by taking thoughtful histories and performing investigative physical examinations supported by modern technology, and then applying nonsurgical or surgical techniques.
The process provides opportunities to positively change the direction of a person’s life. Successful outcomes are associated with improvements in patients’ mental health and social determinants of health.
As part of our commitment to this core relationship, we accept the responsibility of a lifelong commitment and passion for improving our medical decision-making through continued education and prioritizing information used to make the best decisions for patients. The best decisions include not only the shared knowledge through medical literature and other forms of learning, but also a greater understanding of the cost differential between treatment options and better focus on the outcomes patients prioritize in assessing the impact our relationship has on their lives.
Mental health and social determinants of health remain in the background of care. However, there is a movement toward these issues receiving greater weight in our decisions as these have a significant impact on patient outcomes independent of the best possible orthopedic care provided.
With these principles in mind, we should approach each opportunity for learning within the framework of evidence-based medicine. We need to mentally establish the evidence-based foundation of overall care to best serve patients.
For example, we know stabilizing acute fractures of the hip in elderly patients is best performed as close to the event as possible to facilitate mobility, comfort, breathing and personal care, as well as reduce the incidence of associated morbidity and mortality, although there may be disparity when defining the best fixation method. Therefore, we expedite the process to surgically stabilize the fracture as soon as possible, using the technique we believe works best in our hands. Some components of the process are not supported by well-established evidence-based medicine. However, the overall guiding principles and care are rooted in the evidence provided from high-quality studies.
When we are involved in a learning opportunity, we should identify the level of evidence and prioritize its value to incorporate the findings into clinical and surgical practice. The higher the level of evidence, the less likely the results and conclusions will be affected by chance, bias or confounding factors. Understanding the impact of evidence may be further enhanced through systematic reviews and the development of best-practice guidelines, which may define the standard of care and have medical, legal and economic implications.
The hierarchy of evidence has systematic reviews at the top, followed by randomized controlled trials, cohort studies, case-control studies, case series and reports, and lastly, expert opinions. We should pay attention to the level of evidence presented, recognize areas where best-practice guidelines are established, remedy differences or conflicts with current clinical experience, then deliver improved care model to patients.
Understanding and incorporating the framework of evidence-based medicine into daily care of patients can be challenging. A high level of evidence does not exist for a variety of behaviors that many surgeons practice every day, such as injections of anti-inflammatory medications or biologic agents for a variety of joint ailments. Changing behavior is not an easy task as many physicians maintain similar practice patterns based on formal training.
With the pressures of health care and personal economics, patient satisfaction and our desire to do what is best for patients, it is more important than ever to frame educational opportunities with the perspective of evidence-based medicine. Incorporating evidence into our clinical practice will help achieve the personal and professional purpose of providing the best value and service to patients.