Evidence

Not a day passes in medical school without someone teaching us the highest level evidence from the randomized controlled trials, which lie at the heart of modern clinical medicine. Everyone touts it as an elixir to make you a top-notch doctor.

Years ago, when I showed up as a young intern prepared to learn about patients with plaque-clogged heart arteries in the coronary care unit, my senior smiled and asked me the details of big names like ISIS-2 trial. I tried to think of answers to his question how many patients we need to treat with aspirin and clot-busting drug in order to save one life. Following his lead, I was convinced with the power – at least in front of an examiner – of reciting the level I evidence. Doctors love the exact number of absolute risk reduction, perhaps more than they love patients.

With time, I started seeing the need to look beyond the level I evidence. And I wonder how on earth one could ever quantify the treatment benefit of paying attention to bedside manner, asking patients about their concerns (of not quitting his smoking after a heart attack, say), making an effort to remember the name (and not the bed number) of our patients. To truly optimize outcomes for our patients, as Anand K. Parekh wrote in the New England Journal of Medicine last month, we first have to win their trust.