What we will be hearing in the news,
May be helpful in finding clues,
To what is wrong with Aunt Millie's head,
Or the pain that keeps Uncle Joe in bed.
This article is about some new developments in evidence-based medicine making the news. What are these developments, and how do they affect the way we view our patients? Many practitioners would argue that they have been "evidence-based" for as long as they have been in practice. Who would admit to being otherwise? Such an admission would lead to the logical question: "If not evidence-based, then what are you practicing?" That would be a tough question to answer.
The United Kingdom's Center for Evidence-Based Medicine defines it as: "The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients." Those of us in clinical practice who are sensitive to the changing health care demands and responsibilities would tend to agree that practicing evidence-based health care means incorporating and integrating the best individual clinical expertise with the best available external clinical evidence from systematic research.
The myriad of problems inherent in attempting to use this concept is much greater than one imagines. There is confirmation that most clinicians do not read technical and peer-reviewed journals to truly keep up with the explosion in research. One need only review the number of doctors of chiropractic and compare that to the number of paid subscriptions to our peer-reviewed journals. It is clear that, based on the lack of time allocated to reviewing the current research journals, keeping up with research is not a priority, for whatever reason.
To help with the constraints of time, NCMIC and Dynamic Chiropractic have partnered for the past two years to deliver to NCMIC policyholders, a complimentary copy of the monthly Chiropractic Research Review (CRR), which is also available to nonpolicyholders by subscription. This venture attempts to crystallize the current research and provide succinct abstract synopses of the articles currently published, with complete articles available for practitioners in those areas of personal interest. This is one way to bridge the gap between research and the field practitioner.
The next step involves determining true clinical application of the research. Often, quantum leaps of faith are demonstrated in articles written in non-peer-reviewed journals by individuals who extrapolate, and attribute more significance and relevance to a single research project than the principal investigators have made in their conclusions. This, unfortunately, is rampant, and fueled by the eloquence and charisma of the messenger, rather than the substance of the message.
Enter the writing of POEMs (patient-oriented evidence that matters). This concept was promulgated by Allen Shaughnessy,PhamD, of the Family Practice Residency, and David Slawson, MD, associate professor at the University of Virginia. POEM is focused on the clinical outcomes of "evidence-based" medicine. Translated, a practitioner who uses POEM is more concerned with what happens to a patient being treated, rather than simply with the research outcomes and component parts.
This would exhilarate some people because they could jump to the conclusion that all we need to do is listen to patients' complaints and do what we have always done, ignoring any research to the contrary. Not true!
The answer is to find a way to improve upon didactic lectures and written test methods to make the information meaningful to the field practitioner. For years, clinicians have challenged our excellent researchers to "speak English," or at least hire a translator to make research findings understandable. Many excellent concepts and clinically applicable procedures have been suggested in research articles derived from valid studies, yet they go unnoticed and unread by many. These articles are relegated to the hypothetical, theoretical and speculative arenas as they relate to clinical practice, in part because no one translated them in a timely and understandable fashion for the clinician.
These days, many field practitioners are busy tending to paperwork instead of treating patients. The time constraints on clinicians are demanding. The lag time between research findings and clinical application is too long. Research needs to be translated and repackaged so that it can go from the laboratory to the adjusting room, and be relevant to everyday practice.
What should we read? Who should we believe? How should we obtain the necessary clinical information? These are all questions that will become more relevant as research efforts escalate, legal demands increase, clinical demands mount, and legislative reforms mandate incorporation of research and evidence-based practice by every health care practitioner.
With the internet available in almost every office and current information at your fingertips with the stroke of a key, the dilemma of how to make new research applicable to everyday practice will become less problematic, and the solution more commonplace. This information explosion will place greater responsibility upon practitioners to be aware of the changing clinical and research landscape, and leave little excuse for a knowledge gap to exist.
The ironic aspect of the POEM approach is essentially that this "new" approach to clinical medical intervention is just now being discovered in other disciplines. The chiropractic community, almost unknowingly, was using the POEM approach de facto simply because there was limited access to research information for much of chiropractic's history. POEM is an important component to the practice of chiropractic. It is not only effective for dealing with a patient's current condition, it also forces a patient-focused examination, patient-focused communication, patient-focused discussion, and patient-focused treatment built on patient-focused needs.
Chiropractors have for many years been caught between the bookends of science and service, research and relevance, and patients and paper. Now the information explosion has left in its aftermath some very tangible benefits for the provider and the patient. A POEM approach will not only improve the doctor/patient bond, but will improve the clinical outcomes which we all seek. In the final analysis, the patient we serve will benefit immeasurably, and the chiropractic profession will make major strides in closing the gap between blind belief and relevant research.
As I sit to write this verse,
I think of the blessing and the curse,
That we may climb this slippery slope,
Between rational thought and offering hope,
To make the care our patients receive,
Based on more than just what we "believe,"
To search for the best approach to care,
And all the decisions doctors/patients share,
The gentle touch, the caring hand,
Coupled with knowledge to clinically expand,
As patients recognize the new approach to health,
The rewards will be measured by more than wealth,
A changing paradigm, refocused on need,
Making patients our interest and eliminate greed,
The world will see chiropractic anew,
And patients will believe in what we say and do,
For up to now a profession torn,
By silly disputes old and worn,
By refocusing on patients' needs,
Chiropractic will be certain to succeed.
Click here for previous articles by Louis Sportelli, DC.