What is the best solution for the dilemma between evidence-based medicine (EBM) for populations and for individuals, which arises from the tension between general recommendations based on population-level data and the need to tailor medical decisions to an individual’s unique circumstances? What percentage of people in your practice require tailored care?
The dilemma between population-level evidence-based medicine (EBM) and individual patient care is a well-recognized challenge. The best solution often lies in a balanced, integrative approach:
Regarding the percentage of people in practice who require tailored care, it varies by specialty and patient population, but many studies suggest that 30-40% of patients need some form of individualized adaptation of EBM guidelines, particularly those with complex medical conditions, multiple comorbidities, or unique genetic factors. This number can increase in more complex cases or specialized fields.
What is your experience regarding how often you need to tailor care to your patients?
According to the father of evidence-based medicine, David Sackett, evidence-based medicine is not limited to the mere application of evidence dissociated from reality, but rather to a balance between evidence and the patient's experiences, knowledge and culture, in addition to the experiences, knowledge and culture of the healthcare professional, who must also assess the context of healthcare. Both culture and experience have always been a central issue in the failure to apply evidence. On the other hand, not all evidence is of high quality. There is much evidence of low quality that needs to be better evaluated.
This question appears to lack an understanding of what evidence based medicine means. Every person is treated individually. Medicine is one on one of course. We dont treat people in a school room all at once. But every treatment should be based on evidence. Not all evidence is from groups. There are case studies also published. One should not recommend something for which there is no evidence to support its use.
For every patient, we clinicians need to ask if that patient fits the demographic and health categories defined in population-level EBM.
For example, an 80-year-old woman in average health is unlikely to live long enough to benefit from mammograms or cardiac screening. EBM adds up her risks and benefits, finds the risks of screening outweigh the benefits, and recommends against them.
However, an 80-year-old woman in above average health for her age, who bikes to volunteer work, eats a healthy diet, socializes, etc., will likely live long enough to benefit from the early detection that screening provides -- and is therefore a valid exception to the recommendations of EBM for her age group.
Evidence based Medicine must be coupled with experience and knowledge of ground realities regarding the patient, the community and the healthcare system if it is to provide the best care. Medicine is not just science but an art as well.
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