Clinicians must avoid violating professional ethical principles and patients’ legal rights and they may not ever discriminate. So, what does that mean in practice?
AMA J Ethics. 2016;18(3):229-236. doi:
10.1001/journalofethics.2016.18.3.ecas4-1603.
All medical care should seek to achieve one or more of three goals: to prevent future suffering, to relieve suffering, or to prolong life. Detecting low-grade indolent cancer may not further any of these goals.
Although not everything on the Choosing Wisely lists is likely to reduce low-value care, it is a good starting point for a conversation about curtailing low-value interventions.
The Oxford Centre for Evidence-Based Medicine provides a scale for stratifying evidence from strongest to weakest on the basis of susceptibility to bias and the quality of study design.
Physicians should not only avoid forming personal relationships with drug reps but must also acquire and apply numeracy skills and information management strategies to critically evaluating drug reps’ information.
AMA J Ethics. 2015;17(8):729-733. doi:
10.1001/journalofethics.2015.17.8.ecas1-1508.
Conflicts between federal and state laws governing marijuana, lack of evidence about its efficacy as a treatment, and physicians' inability to predict or control dosage would all be aided by reclassification of the drug that would let clinical research go forward.
While practicing evidence-based medicine may maximize the likelihood of positive outcomes in a large population, it does not necessarily yield the best decision in a particular situation. To date, EBM proponents have not figured out how to account for patients’ differences from trial subjects, intangible factors detectable by experienced doctors, and patients’ values.
Karen E. Hoffman, MD, MHSc, MPH and Paul L. Nguyen, MD
Guidelines require interpretation and should not be mindlessly applied as a template of care for all patients, particularly when there are inconsistencies between clinical practice guidelines developed by medical groups.