The Impact of Patient Choice on Evidence-Based Care

Today, physicians are no longer seen as infallible, which is partly because digital technology allows patients access to more information than they've had at any time in history. Increasingly, patients arrive on a physician's doorstep armed with everything from peer-reviewed research and WebMD articles to survey-driven ratings of providers (courtesy of CMS.gov and Yelp).

Patients are seeking more control of their healthcare decisions, especially around chronic or end-of-life treatments. How will this impact evidence-based medicine? How should physicians respond when patients want to discard or discount evidence-based practice in order to exert more control over their own treatment?

The New Digital Normal and Physician Response

JAMA Evidence reminds us that "one of the three key principles of evidence-based medicine is that the evidence alone is never sufficient to make a clinical decision." That's because there are always variables to factor into patient care. Patients may be more or less compliant with their regimen, or may choose additional treatment even when the physician believes palliative care is the best option. How physicians respond in these situations goes to the heart of a patient's bill of rights in defining illness-management outcomes. 

Physicians often face a high level of complexity when weighing evidence-based medicine against the preferences of a digitally informed consumer. As BMC Medicine suggests, patients "live in the messy, idiosyncratic, and unpredictable world," that lacks the clinical focus of a controlled experiment. In addition, the time pressures under which most clinical providers operate today can sometimes preclude incorporating patient preferences, or can contribute to devaluation or even discounting of the patient's input in the treatment-planning process. As a JAMA article drolly suggests, "Clinicians should remember that taking care of patients is supposed to be difficult."

Empowering Patient Choice using Evidence-Based Medicine

The challenge today is that patients may refuse treatment that a physician deems necessary, or they may come in to the office requesting the latest pharmaceutical treatment they have seen advertised on television, which may not be appropriate. Striking the right balance between following patient choice and relying on evidence-based medicine, if the two are in disagreement, is crucial to enabling the shared decision-making that is positive change in the healthcare system.