Medical Practice Far from Toothless: But Clearly Long in the Tooth


By Benjamin E. Ruark

By no stretch of the imagination is it likely that people turn to online chat groups to read posted home cures, homeopathic, and other folk remedies, just to kill time. They tend to migrate to such places when the usual courses of treatment prove ineffective. They may also be looking for shared experiences and social support, but in the main, it’s a hope-filled search to identify some personally untried elixir that will succeed where traditional medicine has not.

As patients, a significant number of us are familiar with healthcare professionals supplying quick answers to our medical complaints. The rub comes when we find ourselves on the receiving end of textbook-parroted prescriptions that, when taken, are seen to either be counterintuitive to a presenting problem, or were already tried and found frustratingly impotent. What we have here is a failure to upgrade: not necessarily the textbooks, nor medical education per se, but you, out there, the staff. You’re the problem. Healthcare workers of all job titles, who get their degree and/or certificate, and show up at work, believing ‘they’ve arrived,’—succeeded in landing a new career—but doesn’t mean their learning stops. Nor that their current performance level is optimal for the current job. To operate on this assumption is to destine oneself to repeat the first year of experience over, and over, and over.

In truth, they’ve completed Leg-1 of their journey. Leg-2 is about continuous learning and upgrading. Leg-2 is partly about learning of advances in medicine, from equipment to instruments, from procedures to improved methods, from topical medications to nsaids. Chiefly, Leg-2 is about individual differences in patients’ reactions to all. Which is polite-speak for “Why aren’t you writing this down? Open your notebook to page__” each time you’re confronted by a medical intervention that isn’t successful. Despite the multitasking madness that’s categorically native to healthcare practice, staff are nonetheless encouraged to keep their own personal spreadsheet of Patient Demographics, Symptomology, Treatment, and Treatment Effects.

Staff would be wise to carry a notebook on their person, for penciling in details about patients in their care; then transferring those details to their personal spreadsheet at a later time. This requires a two-track mindset: administering care, and maintaining a record of actions taken and effects observed. Thus, feedback on observed results is high on their list of hour-by-hour concerns. By doing so trains one’s attention to not only look at the impact medicine is having on different salient variables, but also interactions between observed variables. What’s the payoff? 

Perhaps many recordings of observed effects will prove unsurprising. But maybe one in twenty/more will offer up a solution string of multiple tried remedies that, in a particular series, were observed to accumulate to produce a major, lasting improvement or full cure. It wasn’t that the last remedy did the trick, rather the series itself proved efficacious, perhaps. If so, this may be something that other staff may have unwittingly witnessed before as well, but had no visible record of it—and resultantly, will be destined to forever keep experimenting on a one-off basis. 

Hence, never recognizing that a multi-prescriptive approach to treatment of ‘X’ for a certain gender, or age group, or disease stage, is in actuality a virtual panacea. Or that Variable – or demographic-Q reacts positively to remedy-Z, and so on. Whatever array of factors was observed, it now needs additional demonstrations of replicated results to determine whether its illustrious effects earn (a) formal intent to repeat the intervention suite, and (b) widespread dissemination as a valid candidate for treatment of ‘X.’

Put another way, staff can then refrain from textbook parroting prescribed remedies and, instead, recommend a specific course of treatment based on evidence gleaned from their own practice; thus, an informal definition of practice-based research (PBR). If desired, they can set up the usual research protocols, produce their results; then get them published in a reputable medical journal. In a proverbial one fell swoop, (actually not quite that fast), they’ve moved from anecdotal evidence—which risks being skewed—to hard evidence supported by research rigor.

The point is, in any profession we’re to never stop learning. Without metrics to tell us where the solutions lie, we’re unable to know what’s to be learned and where to apply it. That’s the gist of how not to become long in tooth; have one’s efficacy be limited in the face of longevity. Staff won’t have to refer patients elsewhere on the grounds of being unresponsive to conventional remedies. Staff remain current. Still credible in the judgment of patients. Some staff may even earn an extra title of ‘go-to specialist’ for treatment of ‘X’ for a subpopulation of patients for whom conventional remedies are reliably unsuccessful. As for newbies to select medical professions, they’ve an entire career to devote to achieving subspecializations of choice.

Don’t take too big of a bite in the size of that first spreadsheet, however. Those who elect to informally conduct PBR, consider these criteria: pick one or two troublesome areas where textbook remedies persist in producing hit-and-miss results. Also noted, where patients have been handed off to other clinics or specialists; or where they appear to have an infomal ‘list building’ of thus far attempted-and-failed interventions. Next, determine chances of being personally involved in this area for at least a couple of years. Get permission regarding use of symbols denoting patient names (preserving confidentiality) on the spreadsheet and its purpose being centered on data collection for the treatment of ‘X.’ Then start taking notes, using a personally devised shorthand to keep the notebook recording part quick and simple; i.e., not a work hindrance.

So, from this perspective, at least, there are two options for medical staff: (a) having ‘arrived,’ hope to do one’s best and multiply that hope times as many years of service that lie ahead; or (b) institute PBR as a means of converting patient individual differences in reaction to treatment of various diseases and other illnesses as one’s career-life study. With the intent of achieving a higher rate of success with noncompliant textbook cases, as well as contributing this newfound knowledge to the betterment of medical practice at large. A variation of option-(b) would be to pair off with a close work associate and share talent, time, effort, and workload toward achieving the same end.


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