Examining the Evidence

Dealing with Doctors

In episode 4, Dr. Brinker again joins Dianne and Dr. Crossnoe to discuss evidence-based medicine, and why patients should care about this. Dr. Crossnoe suggests that it is important to understand the evidence in order to evaluate who a patient should listen to and how doctors make clinical decisions.
In order to have a context to discuss this, Dr. Crossnoe presents the case of a patient named Paul, who presents as a new patient who wants screening for prostate cancer. Dr. Crossnoe and Dr. Brinker use this example as a way to discuss the evidence around screening for various medical conditions. They also discuss other situations in which evidence has changed the standard of care in medicine, including tonsillectomies and peanut allergy.
Dr. Crossnoe and Dr. Brinker introduce the listeners to the United States Preventive Services Task Force (USPSTF), which gives evidence-based recommendations about screening for medical conditions. They also discuss the importance of shared decision making and patient autonomy in medicine.
The group then discusses situations in which patients might want certain tests done, but evidence does not support doing the tests. They discuss what makes good research, and that there are organizations and systems who screen and monitor these studies and make appropriate recommendations. Dr. Crossnoe suggests that one major benefit of evidence-based medicine is to avoid clinical bias.
They then return to the case of Paul, and discuss what other screening and health monitoring might be appropriate.
Dianne asks about what to think about recommended guidelines, particularly from the CDC, in the wake of COVID and the controversies during that time. They discuss some of the lessons learned during the pandemic.
The group then returns to the process of research, from initial studies through recommendations and guidelines. As examples, they discuss cholesterol medications including statins and fish oil. They also discuss what happens when new evidence overturns previous practice, such as in the case of the Women's Health Initiative and hormone replacement therapy and new recommendations on Pap smears.
Dr. Crossnoe admits to initial skepticism about evidence based medicine while he was in medical school, and addresses the fact that not all decisions can be made directly on the evidence. They again return to Paul and talk about some of the risks of screening for prostate cancer. They also address screening for colon cancer. They discuss appropriate skepticism in medicine, by patients and by physicians.
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Episode Links: Home page | United States Preventive Services Taskforce (uspreventiveservicestaskforce.org)