Last Sunday I read an excellent article in the NY Times magazine about the head of InterMountain Health Care, Dr. Brent James. He is highly regarded doctor by his peers who has put InterMountain Medical on the map because of his success in reducing mortality rates by evidence based protocols and extensive data collection on best practices. Basically he believes too much medicine is practiced based on a doctor’s story and beliefs and not necessarily on the data or science. It seems he has a very solid base of evidence to support his assumptions and is doing some great work at assisting other doctors in discovering their own biases and agreeing to try set protocols for certain types of illnesses.
I am also reading a book recommended by a friend dealing with Breast Cancer, When the Body Says No, by another doctor Gabor Mate. His research is about how stress is the underlying cause of many immune related illnesses and how medicine refuses to embrace the mind/body connection.
In some way the two reads are directly opposed. Dr James is all about evidence, science, practicing only what which can be proved and not veering into subjective, intuitive wisdom or ‘story’. While Dr Mate’s book is about listening to the stories of many of his patients, his experience with these patients and pulling together research that supports the idea of stress as a major factor in illness and a much more psychological approach to healing.
Some might wonder why I am so interested in both ideas. First, I truly believe the most creative and innovative solutions arrive out of tension, ambiguity and even conflicting or opposing forces. So I like the idea if evidence based research that continually pulls data and observes the data with a keen awareness of how easy it is to impose judgment, interpretation and personal screen on the data. This is really the point of Dr James’ article. He seems willing to continually ask himself and his teams of medical providers to be aware of their own screens while practicing medicine and whenever in doubt rely on the protocol not just the ‘story’. He does not punish non-compliance but instead asked any variation to be documented so that it becomes part of the data. He then can review and use the data to influence compliance going forward.
My medical insurer is a large HMO and is strongly based in offering only evidence-based research. At times, I am frustrated by the less than flexible response of my medical care provider in offering alternative solutions. This is the potential problem with a strict protocol of only evidence based medicine. However, I have found an MD who I believe is a very healthy mix of James & Mate. I have come to her with some thoughts about my needs that were outside of her evidence-based model but she listened and then went about doing her own research. She decided to step out of the set protocol (of course documenting that). Later she told me she even did some trial and error on herself. Of course, this is not a full body of research that would prove she practices with this level of protocol and flexibility across the board, but I liked the way she approached that situation and a few others – both as a science and an art.
I wish there were more people who had strong beliefs and opinions but also were willing an able to have those beliefs and opinions challenged. Whether it is medicine or politics – religion or education – our tendency is a avoid the conflict, the tension and get set in our own ways.
I would hope folks like Dr James and Dr Mate could easily sit down at a table and openly discuss their different approaches to medicine. I would hope a medical training program would make sure anyone going through that program had to wrestle with the tension of evidence vs. intuition, science vs. story and never rule one out completely over the other.
It’s easy to stay within my own comfort zone. But vibrant health seems to exist outside of any set point. It would seem vibrant health care must reside outside of any set point as well.
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