Follow the Evidence
MEDICAL AND MENTAL HEALTH UPDATE
It’s time for medical mythbusters!
First, I will say this with a megaphone in all caps: NO ONE SHOULD BE USING HYDROXYCHLOROQUINE (HCQ) TO TREAT CORONAVIRUS.
Multiple rigorous clinical trials have shown that HCQ is not helpful—and potentially does harm—in patients with COVID-19.
We doctors worship at the altar of evidence, scientific data, and the randomized-controlled trial. We also recognize that (as with everything in life) scientific research is a PROCESS.
Caring for patients basically involves this mathematical equation:
SCIENCE + UNIQUE PATIENT SITUATION + CLINICAL JUDGEMENT = MEDICAL DECISION
Example from yesterday: a patient came into my office complaining of intermittent bloating and crampy lower abdominal pain. After listening to her story, examining her, checking blood work, and understanding the patient in front of me, I made a diagnosis of sigmoid diverticulitis. I then made recommendations (antibiotics, a clear liquid diet, and a follow-up appointment today).
What I DIDN’T do is base my patient’s treatment plan on:
ASSUMPTION: “It’s a pandemic, so she MUST be stressed. Who doesn’t have random aches and pains from all the junk we are eating these days!?? I should just tell her to relax and meditate.”
ANECDOTE: “Yeah, back in college I knew this red-headed gal (what was her name?!) who had this same kind of abdominal pain and she felt, like, A MILLION TIMES better with a heating pad and a good cry. I should tell my patient about that gal and suggest the same thing!”
ANXIETY (my own): “Shoot, this person is sick. What if she has cancer, even though my medical judgment tells me it’s diverticulitis!!?? I’d better prepare my patient for the worst.”
DEBUNKED INFORMATION: “I should tell my patient NEVER to eat popcorn again! Even though the scientific literature has thrown out the theory that popcorn causes diverticulitis, I am holding on to my beliefs—and no one can take them away from me! HUMPF!!”
UNPROVEN TREATMENTS: “Gwyneth Paltrow swears by a fistful of special vitamins to fix bloating. I really liked Shakespeare in Love—and that pink DRESS at the Oscars! She seems legit, therefore she MUST know a lot about medical care!”
THE WAY THE WIND IS BLOWING: “Golly gee, I feel like prescribing something totally out of the box today. Who’s up for an adventure?!”
Long story short: doctors, scientific research, and clinical decision-making are NOT PERFECT. But physicians do slog through medical school, internship and residency training, nerd out in libraries, and go dateless and glamour-free for about a decade to try to get it right.
I am the first to admit I don’t know everything (just ask my kids!), but I do know where to look, who to ask, and how to get help with clinical decision-making when I need it.
I also learn every single day from my patients. They are the best teachers. I also learn from my colleagues, by reading the medical literature, and through experience.
And then there’s science. Let’s respect it. And follow those who believe in it. It could save your life!
I will see you soon. Until then, be well.