I B S — Is Evidence Based Medicine (EBM) The Answer ?

I am presently working on a book about IBS.  It is the quintessential mind/body disease and I have been treating patients who suffer from it for over thirty years.

It is fascinating and challenging because of its paradoxical nature.  While it is never fatal, nor does it lead to cancer or colitis, it can be quite debilitating.  In a word its patients suffer.

Of course the concept of suffering is very Buddhist and the Buddha spoke of his mission teach suffering and the end of suffering.  Our approach and methods are different but our goal the same–to end suffering.

Many physicians rely of what is known as EBM–evidence based medicine.  It is essentially the consensus opinion of 'experts' based on summaries of scientific evaluations.  EBM is considered by many to be the "standard of care". In other words it may actually dictate to some physician what they can and cannot offer to their patients.

On the opposite end of the spectrum of medical knowledge is what is known as "anecdotal medicine" or AM as I'll call it.

This is essentially a physician's experience with one particular patient under specific circumstances.  Professorial, academic, research-based physicians are fond of demeaning the value of AM.

"You can't generalize from that one patient to all patients.  You need the highest level of RCT (randomized controlled trials) perhaps with meta-analysis of scores of studies in order to discover how to treat patients."

I do understand their argument.  The problem is this: as a private practitioner I have a different perspective.  I have a suffering patient who sits in exam room A.  They have come to me with a trusting heart and a deep desire to get better.  My obligation is to do my best to relief THEIR suffering.  EBM does not always offer the solution to that ONE patient.

The reality of treating human beings is simply that they are all different.  Despite carrying the same diagnosis they are unique.  A treatment which makes one patient happy leaves the next feeling worse.

It has led me to seek alternative and complementary approaches.  It has led me to explore the mind/body relationship in greater depth.  It has led me to weigh the risks and benefits of any recommendation.  It has led me to consider acupuncture, Reiki healing, herbal therapies when it seems the best approach.  It has led me to consult with my patients as to how they would like to proceed  when choices arise rather than dictate to them as if they were children. It has made me a pragmatist in the service of their suffering.

It has forced me to do anecdotal medicine.  That one patient IS an anecdote and they want to feel better.

The Buddhist approach requires me to find the way to end THEIR suffering, in that moment of awareness I have no other patients.

 

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