Evidence-based practices are protocols put into play by researching results among trial groups and coming up with the best solution overall. These practices become a standard of care in many medical facilities as there is a clear path of treatment as well as a history of positive outcomes. While the theory makes sense, there are always disadvantages to any protocol. Many of the disadvantages stem from the fact that all human beings are different, but others come from the lengthy processes involved in effecting change or coming up with protocols.
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Time and Money
As medicine moves forward, evidence-based practices take a significant amount of time to change. This leaves outdated protocols in effect instead of potentially more valid treatments. Running a clinical trial takes time. You must study a group of people over a significant period to determine the effectiveness of any treatment. In addition, the time it takes to find the trial group can be extensive. Couple that with death rates, reporting processes, and communication difficulties and the money and time involved in finding an evidence-based solution begin to mount. As the clinical trial continues, changes are constantly made to the protocol, limiting doctors and changing the categorisation of eligible patients. This can eliminate people from the trial who could still benefit from the practice but no longer have access.
Individual Needs and Emotional Neglect
Emotional neglect and failure to account for the needs of individual patients directly conflict with the Hippocratic oath taken by all practicing doctors. According to Dr. Jozien Bensing, evidence-based practices can cause doctors to neglect the individuality of the patient. The protocols currently in play do not offer patients access to the best treatment if it has yet to be "proven." Some doctors, who agree with "patient-centred medicine," think the patient should get to choose her treatment. Furthermore, during the testing process, some test subjects are denied treatment to set up a control group, which receives no treatment or merely gets the "old" treatment. While evidence is being collected, a number of other patients must endure the current protocol, which is likely less effective than the new solutions being tested. While the overall goal is safety for all, it prolongs pain for many.
Insurance companies have become heavily involved with evidence-based practices. This is a way for the company to know how much treatment is going to cost as well as the likelihood of success. This also gives the insurance company an "out" for questionable or new procedures. Often insurance only pays for the current standard of care. This denies access to patients who cannot afford the treatment. Insurance companies force doctors to stick with current methods instead of giving them the latitude of trying new things that currently lack "evidence" for effectiveness, which keeps them from finding individual solutions for patients who are not responding to the current protocol.
Limitations for Creative Solutions
In order to protect the licensure of the hospital, most facilities formulate a standard of practice based on current evidence-based solutions. These standards work well for most, but keep medical professionals from coming up with creative solutions for unique patients. All patients present and respond differently. By tying all patients to the same interventions, the personal care a physician can give is limited. This also plays into the insurance payment scale and into protecting the overall business rather than the individual. Doctors are unlikely to take risks on unproven techniques for fear of being sued or losing a medical license. These untested practices could potentially improve the patient's life but no one is willing to try out of fear or repercussions.
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- Eastern Association for the Surgery of Trauma: "Utilizing Evidence Based Outcome Measures to Develop Practice Management Guidelines: A Primer"; 2000
- "Patient Education and Counseling"; Bridging the Gap. The Separate Worlds of Evidence-Based Medicine and Patient-Centered Medicine;" Jozien Bensing; 2000
- Smith College School Social Work: "Evidence Based Practice"; J. Drisko; April 2010
- SMC Medical Ethics: "Evidence -Based Ethics? On Evidence-Based Practice and the "Empirical Turn" from Normative Bioethics;" Maya J. Goldenberg; 2005
- CancerGuide; Clinical Trial Dictionary; Clinical Trials and Experimental Treatments;