The Ongoing Debate for EBM: fighting for the scientific soul of our profession

I live in two worlds.

tspmg logo, with website Sept 2012

On the one hand, I lead the Permanente Medical Group (PMG) in Georgia – a tight fellowship of 460 MDs, 140 APs, and 140 staff dedicated to the continuous improvement of clinical care we provide to 240K Georgians through 35 specialties in 29 offices and 4 hospitals. We follow the science of our profession (evidence-based medicine), we honor the sanctity of the doctor-patient relationship (emphasizing shared-decision making), we do what’s best for each patient, each time (Hippocratic Oath, anyone?), without incentives to do otherwise (unlike FFS healthcare).


On the other hand, I proudly serve the Medical Association of Atlanta (MAA) as President this year, and Chair of the Board next, and the Medical Association of Georgia (MAG) as a Director. I feel a strong bond to those fee-for-service (FFS) colleagues, many of whom I served alongside at the bedside for 20 years.

With a foot firmly planted in each world I’m on a campaign to raise the quality and lower the cost of healthcare in our state, impeded in part by a reluctance of my FFS colleagues to fully embrace Evidence Based Medicine (EBM) – a physician-led process of continuous clinical improvement that “…

(1) de-emphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision-making and

(2) emphasizes the examination of evidence from clinical research (when available).”

(For the background on the debate, see my post entitled “Intuition v EBM”, which anticipated the MAA debate that took place Wednesday, March 27.)

The debate was unsuccessful in that I was unable to convince most of my FFS colleagues that the definition of EBM does NOT contain the words “clinical protocol” or “clinical guideline”, anathema to many of them.

The debate was successful in that it sampled the opinions and biases of 100 of our 1300+ members, and sought to address the fears of skeptics.

I cannot yet know if the debate moved any skeptics toward embracing EBM, but at least the debate will continue later this year in our MAA Board offsite and the 2013 MAG House of Delegates meeting in October; I am hopeful my FFS colleagues will join Permanente, Emory and other science-minded physicians in embracing the benefits to patients and our profession brought about by the routine incorporation of EBM in our practice.

stephen colbert, sitting square raised eyebrowOr they can follow the example of Dr. Paul Broun, summarily renouncing his or her medical school education, and its scientific foundation.


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