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.
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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TreatmentScores.com. Treatment Scores are about what happened in the past they do
not predict the future.
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© 2015 Treatment Scores, Inc.
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