We shouldn't get distracted by the recent court decision opposing the federal requirement that individuals purchase health insurance. There are many aspects of health reform which are important and scheduled for implementation. Among the key provisions in the new law is one that provides $150 billion in funding for evidence-based care. That's on top of $1.1 billion of federal stimulus spending for new research comparing medical treatments, drugs and devices to evaluate which are most effective.
On the face of it, evidence-based care is straightforward: use research to develop sound evidence on how medical problems can be most effectively prevented, diagnosed, treated, monitored and managed. Good news right? After all, studies have shown that patients who are involved in their healthcare decisions are better able to understand and follow their doctors' treatment plans and are more satisfied with their care. But in practice, it's not so simple.
The success of evidence-based care requires that patients be engaged in their care, trust the information source and understand the evidence. A 2010 study published in Health Affairs found that even among the savviest patients, few understood terms such as "medical evidence." The research concluded that since patients have relied on physicians to make treatment decisions, patients may find it difficult to work with clinicians to evaluate complex and conflicting medical evidence. Clinicians need to work with their patients to help them play a more active role in their own care.
As Barbara Ficarra recently blogged, "by listening and communicating we can understand and guide our patients. Empathy enhances patient-physician communication and trust, and therefore treatment effectiveness."
In the absence of open, empathic communication and strong caregiver-patient relationships, evidence-based medicine will fall far short of its potential to improve the effectiveness of care.
How can we help patients and clinicians understand and evaluate medical evidence?