What is evidence-based medicine? It is statistical medicine, employed by health insurance companies and their academic collaborators, intended to deny you healthcare procedures, tests, medicines and treatment modalities. The new game in town is taking care of the healthcare corporations first, you second.
When I trained, the goal was to look after the patient first, business second, which helps explain why doctors write off so much money each year in failed collections. We were trained to order tests if there was a reasonable chance it might help the patient, and reasonable might mean different things to different doctors, and for good reason. Doctors vary in their skill sets and training. No one doctor can know it all, and so doctors need to order more tests than normal, some more than others. An endocrinologist who treats diabetics regularly is going to be more efficient in ordering the right tests than a family doctor who sees far less per year. What this means is that there has to be some leeway in the kind and frequency of tests doctors may order. A one-shoe-fits-all methodology based upon what the doctor with greater expertise may order will result in a greater morbidity and mortality amongst patients.
As an example, compare Tom Seaver in his prime to a rookie pitcher. Shall we narrow the strike-zone to Tom Seaver’s standard? How well will that rookie pitcher do?
Compounding this variability in doctors’ skills is that life occurs prospectively meaning that a doctor can not see into the future. Everything looks easy in hindsight. Add in the lawsuits for failing to diagnose, plus the reality that doctors are human, not machine, and thus prone to stress and failure, is it any wonder that doctors order more tests and prescribe medicines to maximize patient comfort? Isn’t that why doctors exist? You don’t go to a car mechanic to under-diagnose and under-replace parts do you?
The insurance companies want none of this; indeed, their shareholders demand it. Thus the drive to produce studies demonstrating that tests, medicines and treatment modalities are unnecessary. Has there ever ben a study showing that doctors are under-prescribing or under-ordering? I have not heard of it.
Complementing this, conveniently, is a political correctness to this cost-saving. This manifests itself in such activist positions, arguable, that cold medicines are unworkable and a danger to children under 2 years of age, and that chest x-rays present a significant radiation risk to patients. Regarding the former, one has to wonder how billions of mothers suffered under such a mass delusion for so long. The latter is simply laughable.
Evidence-based medicine is not true medicine at all; it is dogma, moneymaking dogma, posing as science. Unfortunately, you will pay the price. You, Sir, are an acceptable loss.