Caring for the Center of Medicine

At a time when we have the science, technology, and political prowess to propel allopathic medicine forward, a palpable tension has arisen between various movements in medicine and those we intend to help. Whereas a movement like Evidence-based Medicine (EBM) recommends patient-centered outcomes (i.e., mortality, quality of life), weaker outcomes called “surrogate outcomes” (i.e., reduction in blood pressure/cholesterol) continue to be used. This dilutes the type of evidence we have to apply to patient care, divorcing what patients care about and clinicians ought to care about. It’s just that word, “care” that needs to stay involved. As noted by Trisha Greenhalgh, clinical care with an EBM approach has been exposed to “medicalization and bureaucracy” Amidst all of this, the person we should be striving to know, connect with, and care for is the patient. Therein lies the irony, we have a profession based on science which is continuing to wake up to its aims, values, and capabilities.

While these thoughts are not new in any appreciable sense, they are a refresher for me, one ushered in by two events; my read of “Why We Revolt: A Patient Revolution for Careful and Kind Care,” and what has been a bit of reflection on my prior burnout in prehospital medicine, the general aims of medicine, and an investigation of the potential solutions of industry and bureaucracy. As you read this blog, I implore you to walk away with this message: no matter what evidence we do or do not have for a particular treatment, diagnosis, or prognosis the patient was and is the center of medicine.