Tuesday, November 10, 2015

Finding the Evidence Behind Treatments

Finding the Evidence Behind Treatments

SOM® Treatment Scores

Every day I find myself wondering about the details of our treatment options for patients.  Most conditions have an array of options for patients.  These are in addition to the home remedies and Eastern medicine alternatives which patients are inquiring about and are beginning to be trialed in the literature.  One of the toughest decisions we make with the patient and their family is: Which treatment has the best evidence behind it for a particular disease? 

Our medical literature gives us guidance on this question.  We have randomized controlled trials to compare treatments, and we have systematic reviews, Cochrane reviews, and meta-analyses where there is significant controversy.  These studies and reviews build a strong foundation for our individualized conversations with patients.  Increasingly the doctor-patient relationship is becoming more of a partnership with the physician giving advice and recommendations, but also giving patients the options and a thorough discussion about which option may or may not be appropriate for each individual patient.  I find this leads to situations and attempted comparisons made from extrapolation of the literature. 

Here’s an example.  Take the case of a simple traumatic iritis.  No other ophthalmic problems, just a simple mild iritis from blunt trauma without other traumatic sequelae.  The treatment options in this scenario typically include: observation, topical steroids, or topical steroids plus pharmacological dilation.   Seems relatively straight forward – until you consider the individualization of treatment for each patient.  Let’s say the patient is a pilot and will not be able to function if you pharmacologically dilate her eye.  What’s the literature or support for cycloplegia (giving medication to dilate the eye) in simple traumatic iritis?

What has happened to patients who have been studied in the past regarding  true risks and benefits both with or without treatment?  We end up extrapolating from broader literature and attempting to score each treatment for the patient’s situation.  In this case the pilot and her physician may elect not to receive pharmacological dilation, or may choose a short treatment period.  Now imagine the patient was known to develop high intraocular pressure with steroids, or that the patient is a child?  We quickly begin to find that our literature can be somewhat difficult to apply to each and every individual situation and may require some extrapolation.  Hence the Art of Medicine. 

Similar scenarios play out in many disease processes in all specialties every day.  Over the next few weeks I am going to take you step-by-step through a new tool, the Treatment Score Analyzer™, we now have to give a simple, inclusive, and comprehensive comparison of the literature supporting each treatment.  The evidence-based scoring of treatment options will hopefully empower us to make better decisions both for and with our patients every day.  See the disclaimers below.

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Disclaimers:

You must consult your own licensed physician, or other licensed medical professional, for diagnosis, treatment, and for the interpretation of all medical statistics including SOM® Treatment Scores. Treatment Scores are for educational purposes only. Treatment Scores may be incomplete, inaccurate, harmful, or even cause death if used for treatment instead of consulting a licensed medical professional. No medical advice is being given. We DO NOT CLAIM to cure, treat, or prevent any illness or condition. Nor do our services provide medical advice or constitute a physician patient relationship. Contact a physician or other medical professional if you suspect that you are ill. Call emergency services (call 911 if available) or go to the nearest emergency room if an emergency is suspected. We are not responsible for any delays in care from using our website, our services, or for any other reason. We are not responsible for any consequential damages of any nature whatsoever. We make no warranties of any kind in connection with our writings or the use of TreatmentScoresBlog.com or TreatmentScores.com. Treatment Scores are about what happened in the past they do not predict the future.


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