Common Medical Practices Commonly Fail: The Need for Evidence-Based Clinical Decision Support
Guest post by Clyde Wesp Jr, MD and John T. Chang, MD, PhD, MPH, Zynx Health.
For years, physicians would – and many probably still do – advise patients with dust mite allergies to buy allergen-impermeable bed covers to control their symptoms.
The problem: The use of these high-priced linens has no clinical benefit for either allergic rhinitis or asthma, according to studies published in the New England Journal of Medicine.
This is just one example of the overutilization of an ineffective practice in medicine. Indeed, the problem runs rampant, according to a recently published Mayo Clinic study. In fact, researchers identified 146 common medical treatment protocols that offer no net benefits and that either have been or need to be reversed.
Such practices could have unfortunate consequences, according to Vinay Prasad, MD, one of the study’s authors. In a supplemental video to the article titled “A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices,” the oncologist points out that the proliferation of these ineffective practices could cause harm to patients, prompt patients to lose trust in the medical community, and result in unnecessary spending. Just think: Impermeable bedding was once a $26 million industry, according to Prasad.
The Mayo Clinic study, which was based on the analysis of 10 years’ worth of research in the New England Journal of Medicine, is valuable because it opens what we believe is a very worthwhile discussion regarding the value of evidence-based clinical content and clinical decision support (CDS) solutions. Such technology can be utilized to stay on top of emerging best practices and help healthcare organizations improve patient outcomes, enhance safety, and lower costs. By providing such clinical content electronically, healthcare organizations can work toward eliminating the overutilization of ineffective practices and work toward consistently applying standardized best practices at the point of care.
Here are just a few considerations that medical professionals need to start thinking and talking about as they consider the need for CDS technology:
#1: Quite simply, why are clinicians implementing treatment plans that don’t work? To start, medicine is based on tradition. Typically, clinicians learn from their predecessors. Thus, many practices and treatment protocols took hold two, three, or even four decades ago. Therefore, these practices could be based on outdated or incomplete evidence. Indeed, some treatment practices came into being when there was absolutely no corroborating evidence. In such cases, clinicians based their decisions on logic and intuition, simply because that is all they had to go on.