Helping Patients Decide in an Evidence-Based World – Part 1

The role of providers in clinical decision-making has evolved from “the doctor always knows best” to a more collaborative and shared decision-making process. While some have argued that patients often favor being told what to do by a medical expert, the ethical principle of autonomy acknowledges that patients do indeed have a right for having “nothing about me without me.”

In the world of integrative healthcare, it has long been recognized that patients tend to be more self-actualizing and thus, much more engaged in collaborative healthcare decision-making. Integrative healthcare clinicians typically create therapeutic relationships based on collaboration and “meeting patients where they are…”

Evidence based medicine (EBM) consists of three elements. First and foremost are the patient’s preferences and expectations. Second is the clinician’s skill, experience, and expertise applied to the clinical problem. And the final element is using the best available evidence to make an informed decision. This last element can be a formidable obstacle in that the “evidence” is contained in published scientific and clinical research journals that accumulate at a prodigious rate. An individual in a busy practice obviously cannot keep up with the volume of new research that is published every year.

Fortunately there is a growing presence of clinical knowledge databases that can assist integrative healthcare clinicians in assessing the current state of scientific understanding regarding a variety of clinical questions, diagnostic criteria, and therapeutic options. While most of these are conventional medicine-oriented, some of them do a reasonable job of including integrative healthcare options. These sources use technology to perform continuous literature searches and produce up-to-the-minute summaries of the evidence about a wide variety of clinical topics.

Over the next few weeks we’ll be posting information about a variety of clinical reference tools that can be used by integrative healthcare providers. While most are clinician-focused, some also have content that is developed for a patient audience. In either case these tools can provide information for clinicians to help their patients make clinical decisions. By marrying the patient preferences with the provider’s clinical expertise to interpret the clinical literature together they can make decisions based on the best evidence. This is the practice of patient-centered, evidence based health care.