Tag Archives for evidence-based medicine
The Decision Tree by Thomas Goetz is an excellent call-to-arms for personalized medicine and taking control of the options that you, as a patient, now have in our new era of healthcare. Goetz has an extraordinary ability (honed at Wired Magazine) to parse complicated scientific topics into clear and efficient prose.
He touches on many personal stories, some that have been heard before in medical non-fiction (like an Ashkenazi Jew being tested for BRCA1, the genetic mutation that often leads to breast cancer. An almost identical story is related, somewhat ironically, in one of Dr. Jerome Groopman’s early books, but more on him in a minute). Other stories are newer, and focus on some other possibilities of not only genetic testing but also of self-tracking and patient communities, and this is where the book really shines.
Goetz illuminates many of the technologies that are allowing modern patients track and control their health, such as Nike+, 23 and Me, PatientsLikeMe and many others. He also sheds new light on Weight Watchers and explains, by way of what we know now from other self-tracking programs (and other failed diet regimes), why the Weight Watchers model of “points” and group meetings has been so successful for so many.
The one thing that doesn’t quite stack up is the title of the book itself. It is my hunch that using the “decision tree” metaphor to explain the unique choices that we will all have to face as patients is an attempt to legitimize patient activism by translating it into a scientific and statistical model often used in evidence-based medicine (for an example of using decision trees in evidence-based clinical care, see here).
Integrating patient activism into the paradigms of modern medicine is difficult and requires the eloquence and dedication that Goetz provides in this book. Too often patients still meet the locked doors of the ivory tower. But Goetz does a good enough job explaining the different choices each of his examples faces, that the “decision trees” themselves do not add much to the book; if anything, they consistently struck me as over-simplified pictures of a situation just described in detail. It is vital to know and to learn the ins and the outs of your medical situation in order to assist your doctor in your treatment plan. But whether you jot notes in a book or mock-up your choices in SketchUp seems inconsequential.
It is also important that patients not forget the lynchpins of their care in the face of all these wonderful (but often distracting and sometimes frightening) technological tools: their doctors. I recently came across an excellent encapsulation of this book by @Doctor_V as compared to Dr. Jerome Groopman’s “How Doctors Think.” In it, he sets up the two books as opposite one another; the latter arguing for a golden-age of wisdom handed down by Harvard-trained “Masters of the Universe,” while the former seems to push self-tracking and patient activism so hard that there is hardly for a doctor in your care whatsoever. As a librarian, I’ll now be hard pressed to recommend either one without the other.
Global scientific, technical, medical and scholarly (STMS) publisher Wiley-Blackwell today announced the that its evidence-based clinical decision support product, Essential Evidence Plus (EE+), is now accessible from mobile devices. Physicians on the move can now easily find answers to challenging point-of-care questions from their iPhoneTM, IPod Touch®, AndroidTM, Blackberry® or other Smartphones.
The web display works nicely, with sections of each evidence summary cordoned off into separate pages. The “Bottom Line” section of most pages provides grades for the strength of the evidence, something that not all point-of-care tools offer.
Access to the mobile version is free for all current subscribers, but institutional members and those accessing EE+ through their library’s proxy server will have to sign up for a (free) individual account to get onto the mobile version.
One of the advantages of these large publisher-driven EBM tools is that the content is all web-based to begin with and it seems, then, to be a trend that they will develop alternate interfaces for the Web to be accessed by a mobile browser, rather than compartmentalizing their content to be an iPhone- or Android-only app. In the case of EE+, the interface and user experience doesn’t seem to suffer, and physicians can use any web-enabled phone to access the content.
If you’ve got a smartphone, these articles are available free (for now):