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Evidence-Based Practice of Medicine

The field of medicine is in constant flux with an expiration date on clinical facts. A physician practicing primary care medicine would ideally have a knowledge turnover every 5 years. This evidence-based practice of medicine is hard to implement in mainstream clinical settings.

We’ll discuss how we approach evidence-based medicine in primary care for our virtual medical practice.

The Cost of Acquiring Knowledge

The knowledge we acquired in medical school and residency is long outdated; it’s now wrong and perhaps harmful.

To keep up with the rapidly changing field of medicine, we need mentors and time to do independent reading and contemplate how to integrate the information into the workflow of our daily practice.

Time is perhaps the most scarce of resources due to the constant interruptions in standard medical practices.

Here at Digital Nomad Health, our patient panel remains small. And patients are selected based on our expertise and a good match for the practice.

This affords us plenty of time to read, study, listen, discuss, and analyze medical literature that we can translate into measurable patient health outcomes.

Example: Hypertension

Normal blood pressure levels were most recently updated in 2015 in the SPRINT trial. Having someone with a BP above 120/80 is no longer acceptable.

However, the details matter quite a bit. How do we measure this blood pressure to comply with this research study?

Can we use an automated cuff, or is a manual cuff necessary?

If elevated, how effective are lifestyle changes, and how quickly should we start patients on antihypertensives?

When selecting a blood pressure medication, which is the safest based on the person’s risk factors?

Mainstream Definition of Evidence-Based Medicine

Quite a few physicians prefer not to use the term evidence-based medicine (EBM) because the evidence is sourced from subpar research, and there is bias in the interpretation and designed guidelines.

Instead, physicians must turn to researchers and clinicians they trust who digest research studies with little bias. These aren’t easy individuals to access, and much time is needed to understand their content.

Building an Up-to-date Medical Practice

Here at Digital Nomad Health, we approach this problem by identifying the most serious health risks to an individual and our patient population.

For most, it’s going to be one of these diseases which will have the most negative impact on a person’s life:

  1. cardiovascular disease
  2. metabolic disorders
  3. neurodegenerative conditions
  4. cancer

We identify the measurement and interventions with the highest impact in each category and focus most of our resources on those topics.

In CVD, for example, it’s blood pressure and lipid levels which allow for the biggest long-term impact on vascular health.

In metabolic disorders, it’s blood sugar and insulin levels.

Neurodegenerative conditions are best managed through stress, sleep, and exercise factors.

And cancers, though a chance mutation for most, can be caught early through screening and avoided by managing obesity and chemical exposures.

Focusing on What Matters Most

Most of our evidence-based research and education is focused on the factors and areas listed above. Those offer the biggest bang for the buck, the greatest return on time and effort invested.

For some patients, we dive in deeper and determine the need for hormone replacement, a more detailed thyroid disease workup, and management of mood disorders based on the available science.

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