Why don’t you support evidenced-based care?

I’m sitting in my drafty castle, cruising through medical and nursing journals, I realized one thing, why are all these articles so damn boring (Igor asks the same thing when he’s reading Literary Essays…). Lots of folks with diverse educational background love to continue learning even after they receive their advanced degree (Igor on my second grad degree, and hump I really need to stop letting him hang around Karen). I’m one of them. I have a genuine problem, and that is, journal articles are boring. If they’re not boring, they’re on the same subject that you have read hundreds and hundreds of times over into infinity and beyond. Moreover, we wonder why we don’t support evidence-based care…

However, we need to support evidence-based care, badly. I think we all know why, and I could spend pages upon pages of explanation that everybody in medicine would agree with. But they then turn around and keep doing the same thing they have been doing since medical or nursing school, which is usually blundering through their practice like most teenagers on prom night in the back of mom and dad’s car (more on what should be taught in sexual health courses later although I am pretty sure we will still have prom night “mistakes”). Nurse practitioners tend to grasp at evidence-based care because honestly, the nurse practitioner is usually watching the evidence unfold in front of them. I know many physicians are up in arms at the moment about the surge of nurse practitioners, but what they fail to realize, is while we have a similar purpose, we were really designed to serve two different purposes. I talked about this the other day and nursing, is of itself, a time-honored profession. Think of nuns in habits and ladies in medieval garb running onto battlefields to take care of the wounded, or me if that floats your boat. I do look good in a whalebone corset and full headdress.

 

As nurses, we owe it to our profession to continue to advance our knowledge and our skill in nursing and to keep with the latest evidence on effective patient care. Unfortunately, it means those boring journals, the ones that I would just as soon start a fire in my drafty castle with than reading, but they have to be boring. There is enough anecdotal evidence on the Internet to reach to Alpha Centauri and back, but for something to be evidence-based, it truly has to have data that backs up the claim you’re trying to make. Too often we take things we read as opposed to demanding empirical data. If we demanded empirical data, we wouldn’t continue to have a silly argument about vaccines causing autism. For folks in the know and for those who don’t, Andrew Wakefield’s study consisted of 12 people. That’s right, 12 people to make a supposition that vaccines cause autism. Twelve in a world of billions of people is hardly statistically significant. Yet, we still listen to Jenny McCarthy and Deuce Bigelow and were fooled by a study consisting of 12 people.

 

There are many advances in healthcare that are results of evidence-based practice. The biggest one that I can think of is the one that gets patients moving shortly after surgical procedures. The best example of this I can find is people used to lay flat for seven days following gallbladder surgery. In a hospital, very little movement with only bathroom privileges. These days those procedures are usually outpatient. We can attribute some of this to the insurance company wanting to pay less money, but the reason the insurance company pushed for shorter hospital stays is that, quite frankly, the evidence showed a better patient outcome by having them up and moving after surgery. Nursie poo has a background in wound care, and I can’t tell you, in the 12+ years that I’ve been it wound care specialist, how much the field has changed or, how much it has changed since I first went to nursing school 22 years ago.

 

So, what do you do as a consumer? In this day of consumer-based medicine, the typical patient spends much time with my old nemesis, Dr. Google and his minions, the Hippies of Holistic Medicine and their suppliers, The Millionaires of the Supplements Industry. I agree with being an informed consumer by researching a diagnosis that your provider has made. I don’t agree with trying to make your own diagnosis. I know we’re all inundated with stories from the Internet about how the doctor got it wrong and how I cured myself using Google (insert raspberry noise). Ninety-nine times out of 100, that’s not what’s going to happen. You can, however, research the treatments your provider is recommending and discuss those with them or other medical professionals. Take time to look at the medications that you are being prescribed and know them. Reading information about these medications is very important and will help you if you do begin to have side effects. Reading about a medication and watching the TV ad that same medication will give you 2 different outcomes. Watching the TV ad for a medication will make you think that anything under the sun is a possible side effect with that medication, and it’s not necessarily true. When a medication is being tested, the drug company is required to report any potential patient reactions to that medication. The most common reaction to any medication is diarrhea and constipation. That is simply because of what they put in the pill to hold it together. Read about it but try the medication as well. There are lots of wife’s tales about side effects of medications that you may never have. If it didn’t work for your mother, it might still work for you.

 

If something your provider is telling you doesn’t seem right or right for you, it’s always good to get a second opinion from another real, living and breathing provider. I know I’m tough on looking up your symptoms on the Internet. However, there’s a lot more to a diagnosis than simply putting things into a search engine and hoping to hit the jackpot. I know with the current healthcare crisis in this country that a lot of us are trying to do just that. It doesn’t work as well as you think it might and honestly can take a real provider some time to pick through these diagnoses.

 

Well, a whole new pile of nursing journals just came along with Karen and her large mob with torches and pitchforks, so Nursie poo must be off.