Episode #32 – Reframing How Doctors Make Clinical Decisions – an interview with Dave Slawson MD, Professor of Family Medicine & Internationally Renowned Lecturer in Evidence-Informed Decision Making & Information Mastery.
The literature would suggest that a significant percentage of clinical decision making is not well supported by evidence-based literature. Given the vastness of the emerging literature, combined with how rapidly it changes, it’s nearly impossible for any individual provider to keep up. Compounding this issue is the fact that the physiology-based reasoning we were all taught is no longer adequate. Adding fuel to the fire is the predominant fee-for-service reimbursement system which strongly incentivizes providers to do more rather than less; and a tort reform system which also compels providers to do more rather than less.
Fortunately, Dr. Slawson and his colleague – Allen Shaughnessy PharmD, along with many other informaticists and evidence-based experts, have been working on a solution. In this interview you’ll hear how he and his colleagues have reframed the way physicians and other healthcare providers can and should go about making evidence-based decisions.
Here are some highlights:
- The most significant shift required in our clinical reasoning and decision making is to what Dr. Slawson describes as “probabilistic analytics & science”. This quantitative approach disrupts the inherent fallacies of human decision making.
- We need to shift from process metrics to outcome metrics. This is a shift from treating the numbers, such as blood glucose, to treating the patient – that is, focusing on the outcomes that matter, such as heart attacks, strokes and deaths.
- The shift to consumer-centricity & shared decision making is also of utmost importance. If decisions are, in fact, going to be made about value-based outcomes; and if we agree that patients, as consumers, define the value proposition; then any decision that is made without the patient’s shared input and preferences is going to be flawed.
- This approach, far from being a ‘cook-book medicine’ imposition on providers, actually offers immense support and guidance. It will improve the clinical care of patients; and it will provide much needed relief for physicians – allowing them the time and energy to focus their attention on their patients, instead of constantly hunting and foraging for the latest clinical updates.
One of the most meaningful messages that Dr. Slawson leaves us with is a “prescription to say ‘No’.” ‘No’ to unnecessary tests, imaging studies and invasive diagnostics. ‘No’ to wasteful and potentially harmful medications & treatments that are not indicated. ‘No’ to making decisions based on outmoded data and antiquated reasoning.
One of the major lessons I came away with from this dialogue is that it’s not only what we do that can make a difference; it’s what we can stop doing that can really make a demonstrable positive difference in improving patient care and health outcomes.
As always, I hope you get as much out of this interview as i have!