Eminence Based Medicine is a phrase I heard on one of my favorite podcasts, Freakonomics, which was talking about “Bad Medicine” and the fact that the more we actually investigate what we’re doing, the more we find out we don’t know what we’re doing.
The episode starts by investigating 98.6 and the methods used to determine the “normal temperature” of humans. Fascinating story short, the methods were flawed, the tools were flawed and the conclusions shoddy at best. Have a listen for the full story.
As they point out in the 3 part series, we think of medicine as being highly scientific but, it turns out, we have only really embraced evidence based treatments in the last 20 years. Within my service time.
That should frighten everyone.
Dr Vinay Prasad, a Hematologist-Oncologist and Assistant Professor of Medicine at Oregon Health University was a guest on the show and uttered the phrase that titles this post. He was comparing evidence based medicine to previous practice, demonstrating that until recently we went with what the oldest, most experienced person in the room did and assumed that was the thing to do. Eminence Based Medicine.
We in EMS LOVE our war stories, our observations passed along as fact and the EMS Anchors who spin yarns about the old days when things used to work, long before all this new fangled BS came along.
EMS is an expert in Eminence Based Medicine.
How else can you explain most of the “treatments” we apply to patients, specifically trauma and cardiac arrest, arguably the places we can make the biggest difference in patient condition? Or can we? Have we become so entrenched in a skill set that we have forgotten to review what we do for effectiveness?
Or do we know, deep down inside, that most of what we do has no basis in fact?
If data was properly collected and reviewed that showed that cardiac arrest patients had better outcomes if a peanut butter sandwich to the chest was just as effective as a mechanical CPR machine, how quick would EMS implement it?
If no evidence existed for said intervention, say if it only mirrored the outcomes for patients without it, would we still be so quick to make sure it is on every rig?
Do you think I’m still talking about the peanut butter sandwich?
Evidence Based Medicine will drastically change the EMS landscape. Yes, skills will be decreased in favor of more specific interventions and application of technique. Some of our brothers and sisters will cling to their laryngoscopes so tightly, citing bad studies and flawed data, instead of hitting the airway lab to maybe get better. Cardiac arrests filled with drugs and drips and cooling and tubes may be reduced to BLS calls, not because the ALS is hurting, but because we’ll learn that most cardiac arrests did not start in the heart and can not be addressed with our narrow arsenal of cardio toxins.
“We’ve always done it that way” are he 6 most dangerous words in EMS and yet are the basis for most of what we do. Don’t believe me? Look at the push back against eliminating long spine boards, the sudden reversal on pre-hospital cooling (although the data has always been the same) and the fact we are still transporting patients in cardiac arrest to the hospital.
If we demand evidence for new treatments we must also demand evidence for existing treatments. All of them. Perhaps it is not the poorly educated EMS masses we complain about that are leading to poor outcomes but instead our blind devotion to the comfortable, time honored tradition of looking to the oldest, most experienced person in the room and asking them what to do.
Otherwise, what are we even doing anymore?