We live in an evidence-based, evidence-seeking world. We want numbers and data for everything. But in the real world we live in, day to day with our patients, what do we use for evidence?
Here is a true, and very funny, example of real life evidence: One of our patients is a woman who suffers temperature instability due to autonomic neuropathy. She has terrible hot flashes and uses cold compresses for this. The flashes became so severe she turned to using frozen chicken breasts held against her forehead. She came into the office holding a frozen chicken against her head. She needed to do this almost every day. We began treatment for her autonomic neuropathy with electrical stimulation and lidocaine injections, not knowing if there was anything that could help. Surprisingly, she began needing fewer frozen chickens each week, and for the past several weeks has not used any. In the office, we all laugh and say “no frozen chickens.”
Do fewer frozen chickens mean our treatment helped? Could we publish data on number of frozen chickens used over time? Hardly.
Clearly our patient is having relief from her hot flashes, but whether it is due to our treatment is unknown. Perhaps it was the suggestion that we were treating (or trying to), perhaps it was normal progression of her symptoms and they were going away anyway.
So how is this evidence-based? Certainly this is a very humorous way of characterizing symptoms, but it is patient-centered evidence. Is that a new term? It means listening to our patients and using the statements and symbols they use to help us understand the problems they experience. I doubt that frozen chickens will ever show up in a Cochrane review, but they are important to the care of this patient. Reducing the number of times she resorts to a frozen chicken is a great victory for her.
This is symbolic of how medicine is practiced. We all make decisions and choices based on what we know. If a treatment worked for one, we are likely to try it for another; and conversely, if we had a bad outcome, we are less likely to try that again. We are forever making decisions on sample sizes of N=1. It is impossible for us to practice using only “evidence-based” information. Sometimes that is available to help us make a decision, but often, it is not. So for our “frozen chicken” lady and others like her, we just try the best we can, using the information and feedback from our patients as our evidence. This patient-centered evidence is often the only evidence we have.
About The Author
Aletha Tippett MD is a family medicine and wound care expert, founder and president of the Hope of Healing Foundation®, family physician, and international speaker on wound care.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.
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