Question

1. What conflicts exist between the patient’s needs and values and the best available evidence and clinical expertise of the nurse and physician?

Answer 1

Conflicts exist between the patient’s needs and values and the best available evidence and clinical expertise of the nurse and physician. Evidence-based medicine is the integration of best research evidence, with clinical expertise, and patient values. Evidence-based medicine is a process of turning clinical problems into questions and then systematically locating, appraising using contemporaneous research findings as to the basis for clinical decisions. Population-based outcomes research has documented that the patients who do receive evidence-based medicine have better outcomes than those who don’t.

Patient-centred medicine is providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that the patient value guide all clinical decisions. It empowers the patient to assure the patient's preferences are taken into consideration.

However, there is evidence from research showing that patient-centred medicine has advantages of greater patient satisfaction scores, better patient compliance, higher self-reported functional outcome scores, and few malpractice claims against healthcare providers. The paradigms of evidence-based medicine and patient center medicine should complementary synergistic Ideally. In reality, they can be at odds. The focus of evidence is pathology oriented not patient-oriented. The healthcare provider uses evidence to make recommendations to the patient, the recommendations may or may not match patients values and expectations.

The potential discord between evidence-based and patient-centred approach is becoming more common because of the cost factor. Often patients desire and expect multiple expensive diagnostic testing and the latest and most expensive interventions. The best available evidence may document better outcomes with fewer less expensive diagnostic tests, less expensive interventions. Health insurance companies often deny payment for treatments which lack evidence of effectiveness. Many of the complementary and alternative based interventions do not meet the standards of evidence-based medicine. With mpore cost of health insursnce shifting to the individual because of higher deductibles and higher co- payments or co-insurance individuals need to embrace the concepts of evidence based medicine.

Healthcare providers have skill or bias in either evidence-based or patient centered medicine. When choosing a healthcare provifdee knowing the predisposition regarding evidence based versus patient cantered medicine can help guide you whether you should be trusting, sceptical, or finding another healthcare provider.