embracing Evidence-Based Medicine

Shortly after Kelly and I first moved to Bellingham, we began looking for a dentist. I have always (fairly) consistently brushed, flossed, and gotten yearly cleanings, and other than a few fillings and wisdom teeth removal, I have been pretty lucky with my oral health. That is, at least, until COVID. Between my work schedule and the difficulties finding a dentist during the beginning of the pandemic, I had gone over two years without a cleaning (I know, I know), and needed someone to help get me back on track.

I found a local provider, and after an initial meet-and-greet, got a cleaning scheduled. The results of my initial exam sounded promising, but I did have some early signs of gum disease. About 50% of people over the age of 30 have some level of this, but I wanted to do all I could to keep this from causing issues down the line. Along with recommendations for some more frequent cleanings, it was also recommended that I get a saliva test to check for the presence of certain bacteria that may be used to guide future treatments such as antibiotic selection for more serious cleanings if needed. While the test wasn't covered by insurance, I was assured this was evidence-based and because the doctor recommended it and I was trying to again get serious about my oral health, I agreed. Besides, this guy has hundreds of five-star Google reviews. He must be legit, right?

My teeth felt pretty great after my visit, and the dentist seemed cool, so I left feeling much better about things. Those feelings started changing once I decided to learn more about the test that was ordered. While there was research available discussing potential links between certain types of bacteria and gum disease, there wasn't any data suggesting that this test is actually useful, and as a result, no professional dental association currently recommends its use. I thought that surely I must be mistaken, and spent a substantial amount of time looking into international research on the topic. There was nothing to suggest my dentist had made a good recommendation.

After confronting the dentist, he tried pointing to a few studies suggesting the possible links previously mentioned, but nothing to actually support recommending the test. I was not only upset that I had wasted money on a useless test, but that others in my community were doing the same. Either this dentist knew the test had no legitimate scientific backing and was using insufficient evidence to mislead patients and to line his own pockets, or he believed without evidence that it should be guiding his treatment, which can be incredibly dangerous. Neither of these options were acceptable to me, so I again began searching for a different dentist that I could trust with my oral health.

I was very fortunate to have taken numerous undergraduate and graduate courses in statistics, as well as participating in research projects throughout my education, giving me tools to help navigate the complex world of medical research and biostatistics.  As medicine is constantly evolving, being able to read and interpret research is necessary to stay up to date and ensure you are both providing the best care, and importantly, not doing harm. Providing this type of care is utilizing evidence-based medicine (EBM), and is an essential guiding principle that helps ensure the highest quality of patient care. Let's delve into why embracing evidence-based medicine is crucial for both healthcare providers and patients!

The Foundation of Quality Care:
At its core, evidence-based medicine revolves around making clinical decisions based on the best available evidence from well-designed research studies, clinical trials, and systematic reviews. This approach emphasizes using data, rather than anecdotal experiences or tradition, to inform medical decisions. By determining the validity of, and integrating the latest scientific findings into practice, healthcare providers can offer treatments and interventions that are proven to be safe, effective, and tailored to individual patient needs.

Benefits of Evidence-Based Medicine:

1. Improved Patient Outcomes: EBM ensures that medical decisions are grounded in rigorous research, leading to better patient outcomes and reduced risks of adverse events.
2. Enhanced Clinical Judgment: Healthcare providers who embrace EBM are better equipped to evaluate the validity of clinical research and apply it to real-world patient scenarios, leading to informed and effective decision-making.
3. Optimal Resource Utilization: EBM helps avoid unnecessary tests, treatments, and procedures, resulting in cost-effective care and efficient use of healthcare resources.
4. Transparency and Accountability: EBM promotes transparency by encouraging providers to explain treatment choices based on evidence, fostering trust between healthcare professionals and patients.

The Journey from Research to Practice:
The journey from research to clinical practice involves several steps, each crucial in integrating evidence-based medicine:

1. Research and Evidence Synthesis: Scientists conduct research studies and synthesize evidence through systematic reviews and meta-analyses, producing reliable data on treatment efficacy and safety.
2. Clinical Guidelines: Expert panels develop clinical guidelines based on the synthesized evidence, offering healthcare providers clear recommendations for various medical conditions.
3. Shared Decision-Making: Patients and healthcare providers engage in shared decision-making, discussing available treatment options and considering patient preferences and values.
4. Clinical Implementation: Healthcare providers incorporate evidence-based guidelines into practice, considering patient uniqueness and clinical expertise.

Challenges and Nuances:
While evidence-based medicine offers significant advantages, its application also faces challenges. Variability in patient characteristics, limited availability of high-quality evidence, and the need to balance clinical expertise with research data are all factors that require careful consideration. For example, just because multiple well-constructed studies on a particular treatment done in Miami, Florida show excellent results, this doesn't necessarily mean we would have the same findings if we did the same study in Bellingham, Washington. This doesn't necessarily mean there was a problem with the research design, but rather, seemingly small differences between the two cities' populations (amount of sunlight, diet, levels and types of exercise, etc, etc) can mean drastically different results. This is why understanding population and individual patient characteristics is a critical part of delivering the best care.

Empowering Informed Healthcare:
As patients become more engaged in their healthcare journey, the demand for transparent, evidence-based decision-making is on the rise. Embracing EBM empowers patients to actively participate in their care, making informed choices aligned with their preferences and values. Evidence-based medicine is the cornerstone of modern healthcare, ensuring that medical decisions are rooted in scientific research, leading to improved patient outcomes and optimal resource utilization.

By fostering a culture of continuous learning, critical appraisal of research, and thoughtful clinical implementation, at Bellingham Bay Foot & Ankle Specialists, we deliver the highest standard of care to our patients.