Evidence based medicine critisim: Eating Soup with a Fork
Donald M. Berwick, MD, MPP, President and CEO, Institute for Healthcare Improvement On Demand: Eating Soup with a Fork
Today I watched/listened to an outstanding presentation by Donald M. Berwick, MD, MPP, President and CEO, Institute for Healthcare Improvement titled: Eating Soup with a Fork.
He answers one of my skepticism about the usefulness of evidence based medicine (EBM). He points out that using Randomized Control Trials to find the usefulness of complex processes is misleading. For example the RCT done to find the usefulness of cardiac events rapid response teams that these teams make no difference in outcome. These are multidisplinary teams that are mobilized once a cardiac event (mainly a myocardial infarction) is realized. RCTs are good for finding the usefulness of a drug or a surgical procedure. RCTs are misleading if used incorrectly to find the usefulness of complex process as rapid response team, anticoagulation clinic and complex stroke rehab programs. He points out that to perform RCT we blind ourselves of what is happening and just focus on one point or problem. In complex systems we need to know the details of what is happening to seen what things when available we get the desired outcome. This is common in business. The authors of the business book Good to Great when on looking to see what made good companies good.He points out that we need new ways to learn. We need to way to produce new knowledge. I am left with one criticism against EBM need for RCTs. RCTs take too, too, long and will never answer all our questions. So, Should we just stop thinking till we have RCTs?I totally agree that we should never go to the pre EBM era. But we truly need new ways to discover new knowledge in medicine. Methods that would give us the confidence that RCTs give.
