Evidence – Bah, Who Needs It?!

Remember the movie Treasure of the Sierra Madre? One of the banditos threw that classic line at Humphrey Bogart: “Badges? We don’ need no stinkin’ badges!” Whenever there is a new regulation imposed for which there is no evidence, I can just see some legislator, adviser, or bureaucrat twirling a handlebar moustache exclaiming: Evidence? We don’ need no stinkin’ evidence!

You expect your doctor to do her homework, reviewing the literature and doing tests before making a recommendation for your treatment. That is called good medicine, a form of structured decision-making.

Why is evidence-based decision-making mandatory for those who provide health care, but not expected from those who manage or regulate healthcare?

What patients experience during health care is the result of decisions made by providers and by managers and by regulators. If we want good outcomes – error-free medicine; reduced cost; easy, friendly service; and constantly improving quality – then we need to hold all three decision-makers to the same standard.

ALL decision-makers should be required to have evidence.


System MD

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#1 We’re Drowning And Your Coming With Us — Medical Malprocess on 10.25.09 at 4:08 am

[...] is the accepted standard that your doctor or nurse makes evidence-based decisions and bears the consequences of bad outcomes. Managers and regulators affect patients at least as [...]

#2 The Fix That Fails, And Worse — Medical Malprocess on 10.25.09 at 4:15 am

[...] because of more acute asthma attacks (that were not prevented). Systems analysis and production of ad hoc evidence would have prevented all these fixes that failed or made things [...]

#3 Are You A Systems Stinker? — Medical Malprocess on 10.26.09 at 3:22 am

[...] thinking has loops not lines; evidence before action; plans for various contingencies; and proper feedback. Systems thinking would have [...]

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