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Why People Fear Evidence-Based Medicine

09 Jun

Although a majority of Americans probably couldn’t give you an accurate description of the differences between fascism, socialism, and communism, they have no trouble applying–and often interchanging–those labels to any effort by government to reform health care. And, based on their efforts, one might conclude that the defining characteristic of any government involvement in health care is rationing. As if we don’t already ration, but will as soon as the government intrudes.

Now that isn’t to say that there aren’t some legitimate concerns involved in expanding access to health care in this country, because there are. For instance, we already have areas in this country with a shortage of physicians, and when uninsured people are suddenly insured, their demand for services will be actualized and the physician shortage will be exacerbated. Some people take that to mean that they won’t be able to see a doctor without bread line depression-era style waits. I don’t think that’s remotely close to what will actually happen, but even if it did, there would be a simple fix: produce more doctors in this country. Plenty of smart, talented people are denied admission to U.S. medical schools every year. I honestly do not think that the quality of U.S. medical care would suffer by extending enrollment at the margins.

Then there’s the issue of rationing that people fear will go on at the doctor’s office. They worry that in a governmental effort to “pinch pennies” patients won’t be able to get the best care like they supposedly can now. There’s a tremendous amount of concern about the idea of evidence-based medicine. Apparently people don’t trust the name–or else they prefer their treatments to be based on something other than evidence. An article just published in Health Affairs gets to the root of these fears. The study’s authors basically find that people don’t know what evidence-based medicine really means, don’t tend to get involved in decision making about their health care (preferring their physicians to make the decisions), and continue to hold on strongly to the belief that more care–and more expensive care–is always better. You would think that an entire nation of people raised up on the fairytale of Goldilocks and the Three Bears would realize that extremes in either direction aren’t usually the best course of action. Still, the authors found that people translate the phrase evidence-based medicine to mean that the government steps in and tells doctors how they have to practice by establishing evidence-based guidelines that can’t be overridden or changed in any way. That view, unfortunately, is just plain wrong, and explains how the public’s misconceptions remain one of the greatest barriers to improving our health care system.

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2 Comments

Posted by on June 9, 2010 in Uncategorized

 

2 responses to “Why People Fear Evidence-Based Medicine

  1. Jan Baer

    June 10, 2010 at 10:26 am

    Patients have been unaware that they've been receiving evidence-based medicine for years through insurers. Insurers don't make money paying for procedures known to be ineffective, and that's actually where "the bar" is set.Until two years ago, many people believed they paid the full cost of their employer-sponsored health premiums, when they were actually paying an average of only 18% to 25%.Before health reform became headline news, these same people did almost nothing but complain about the cost, quality and inconvenience of employer-based health insurance, but I have noticed they seem to have become more appreciative as the facts were publicized and they realized what they would be paying for the same insurance on their own, as my husband and I have had to do for many years.If nothing else it has been a learning experience and if these people are fearful of losing their employer benefits – they should be! That's a good thing, actually, because it's a major benefit they had been taking for granted.It is, however, rationed!

     
  2. Robert Dunbar

    June 10, 2010 at 2:08 pm

    While nowhere near universally applied, many physicians have provided and many patients have received evidence-based care for years. Further, in great part this is not the result of carrot and stick type insurance policy, but the result of carefully conducted basic science and clinical research that provides the very "evidence" that such treatment is based upon.

     

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