COURSEREFLECTION

1.)Analyze the benefits to patient care from clinicians using evidence-based medicine and research.
2.)Reflect upon your knowledge, skills, and attitudes pertaining to the practice of evidence-based medicine.
3.)References for this self-reflection are optional.

I HAVE ATTACHED SAMPLE FROM OTHER STUDENT.

1. Analyze the benefits to patient care from clinicians using evidence-based medicine and research.

Evidence based medicine (EBM) is the foundation on which sound medical principles are established. From the first day of medical training until graduation every medical provider is immersed in the pool of EBM. Therefore, EBM must be understood, accepted and lived by each individual who hopes to practice medicine in a responsible way with their patients best interest in mind. .

In general the lay public is not well versed in EBM which makes them more vulnerable to less-than-ethical information presented on TV and the internet. Public assumption often develops based on a mix of half baked science and biased opinion founded in various agendas. This can have a detrimental effect on patient welfare and health if not corrected by clinicians well established in EBM. Worse yet, medical providers who choose to abandon well founded scientific principles and ignore EBM can cause potential harm to those who listen to them and take their message to heart.

An example which illustrates the fundamental danger caused by ignoring EBM is personified in Andrew Wakefield. A former physician who erroneously claimed that a link existed between mumps, measles and rubella vaccine (MMR) and autism.1 Although the study was initially published in Lancet, it was later retracted with further studies unable to validate any of Mr. Wakefield’s findings.1 Fast forward to the present, despite scientific evidence showing no link, the anti-vaccination movement is now well established and entrenched, increasing the risk of children everywhere.

2. Reflect upon your knowledge, skills, and attitudes pertaining to the practice of evidence-based medicine

As discussed in the first section, EBM forms the foundation of good medicine. However, in my own personal experience, the biggest challenge implementing EBM in clinical practice is overcoming insurance restrictions. Here in California, Medical (California Medicaid) is managed by private third party insurance companies. Companies such as Blue Cross, Blue shield and River City are privately owned insurance conglomerates that unfortunately are motivated by healthy profits for shareholders. The effect trickles down into medical decision making often clouding the fluidy and continuity of patient care. It is commonplace to see prescribed medications and diagnostics (selected because of established EBM) be denied by insurance carriers based on their “medical opinion”. This typically instigates an appeal process which goes back and forth, with the insurer, in an attempt to win approval for patient modalities.

Beyond this, EBM continues to evolve and I must evolve with it. In fact, if a clinician’s practice doesn’t change over time, he or she runs the risk of becoming complacent and their intellect stagnant. Our patient’s assume we are competent, but it’s our responsibility to remain so. This can only be accomplished by continually learning the newest developments in EBM and applying those principles in a responsible and ethical way. Medicine is our craft and it is a noble thing. To honor it, we must humble ourselves and accept that we will never master it, but instead will always need to learn, study and strive to remain relevant.

Reference:

Rao TS, Andrade C. The MMR vaccine and autism: Sensation, refutation, retraction and fraud. Indian J Psych. 2011;53(2):95-96.
EXAMPLE 2

Evidence-based medicine (EBM) is defined as “the conscientious, explicit and judicious use of the current best evidence in making decisions about the care of individual patients.”1 In the past, clinicians did not have access to medical research as we do now, so they rely solely on their judgment and experience in treating certain diseases, and what they learned in medical and PA schools. However, today we know that is not how clinicians treat patients, but instead, they use medical research results to help guide their treatment decisions. EBM has an immense impact on modern-day healthcare delivery and practice. When the clinician encounters a patient-care decision, optimal medical outcome demands the clinician’s knowledge and application of the relevant and available evidence. This process can be achieved using the 5 A’s approach that we learned earlier in this course: ask a structure question, acquire relevant evidence, evaluate the applicability of the findings to the patient care, and act which involves the patient’s decision-making process.1 Clinicians must keep in mind that not all evidence is alike, and some evidence is better than others. For example, one treatment may work for some patients, while the same treatment may not work on others with the same medical condition. Therefore, the clinicians must weigh the risks and benefits of each treatment carefully before implementing the treatment. Medicine is evolving rapidly, so clinicians must keep up with the current research and medical advances to apply the best treatment options for their patients to achieve optimal outcomes.

I utilize EBM in my practice every day as an orthopedic PA. EBM looks at all the research there is about a disease or condition. Therefore, when researchers study a disease, they usually observe many more patients than I ever would in my PA career, so I rely on EBM to guide me in my treatment decision. However, this application process also involves chiefly on the patient’s preference. For example, the recommended treatment for full-thickness rotator cuff tear in a forty-year-old patient may not be the best treatment option for an eighty-year-old patient with heart disease and other comorbidities. I consciously involve my patients in the treatment decision-making process, including going over their x-rays, MRI findings, and different available treatment options. Moreover, I present the risks and benefits of each treatment and allow the patient to decide which treatment is best suited for the patient.

In conclusion, EBM is available to assist clinicians in their treatment decision-making process. However, clinicians must be mindful and vigilant about which treatment is appropriate for their patients with specific diseases or conditions, while considering their social and economic status.

Reference

1. Kamath S and Guyatt G. Importance of evidence-based medicine on research and practice. Indian J. Anaesth. 2016 Sep; 60(9): 622-625. Doi: 10.4103/0019-5049.190615