Practice of medicine is an art practiced through a scientific approach. A doctor, like a detective, listens to the patients problems, finds out the clues through further questioning and examination of the patient and laboratory/other investigations, arrives at the logical diagnosis and starts the treatment that has been scientifically proved to be effective in that clinical condition.
This approach of scientific inquiry and logic based decisions is called evidence based medicine and is defined as:
“An approach to practicing medicine in which the clinician is aware of the evidence in support of clinical practice, and the strength of that evidence”.
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It is also defined as:
“Conscientious, explicit and judicious use of current best evidence in making decision about the care of individual patients while integrating individual clinical expertise with the best available external clinical evidence from systematic research”.
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It involves collecting and evaluating the evidence and its relevance, establishing the linkage with the patient’s clinical condition, further investigations whatever necessary, diagnosing the disease on the basis of collective weight age of the entire scientific, clinical and laboratory evidence and starting the treatment justified and mandated by the evidence rather than relying on hunches and intuitions.
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Many doctors, however, ignore this scientific approach and prefer to base their decisions on considerations other than merit such as intuitions or the overkill instinct prescribing the costliest and the latest medicines to ensure relief to the patient knowing very well that there are other alternatives available which are cheaper, simpler and just as effective. Sometimes, it may just be to satisfy a rich patient’s ego and sometimes because the doctor has to prescribe and promote a particular product in return for some favors, gifts or gains.
This intellectual dishonesty on the part of doctors can cause a lot of harm and compromise the patients’ safety due to indiscriminate prescription of medicines (antibiotics), avoidable waste of patients’ money, increased chances of complications and increase in drug resistance.
When the patient will actually need that medicine, it may no longer be effective. This unscientific, indiscriminate and unjustified use of medicines has become a cause of concern world over, as it is doing a lot more harm than any good to the patients.
The safe approach or evidence based approach has three essential elements:
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1. Evidence based diagnosis
2. Rational use of drugs
3. An antibiotic policy
Evidence based diagnosis would mean diagnosis based on sound principles of medicine, positive (or negative) findings elicited through detailed history taking and physical examination, symptoms that are verifiable, signs that are demonstrable and lab reports that are unambiguous and repeatable. It means a diagnosis supported/confirmed by positive scientific evidence and not hunches or intuitions.
Similarly rational use of drugs would mean breast minimum use of drugs, only if logically indicated and of scientifically proved value and up to the strength and length of period justified on the basis of the present level of scientific knowledge.
Antibiotic policy means laying down the policy guidelines about rational usage of antibiotics by all medical professionals.
Ever increasing antibiotic resistance due to indiscriminate/ illogical use of antibiotics is becoming a serious threat to the lives of many patients all over the world.