The Importance of Evidence

I listen to a lot of podcasts. A lot. From podcasts about medicine to comedy to news, there is always one running on the background on my phone.

Recently, I was listening to a podcast in which I rolled my eyes so hard at comments by a certain celebrity with a certain successful and controversial lifestyle company that even my infant son was amused. The celebrity’s takeaway: There are two, equally important schools of thought with regard to evidence—the anecdotal and the evidence-based.

On one hand, journals like Annals of Internal Medicine are important because so much of modern medicine is built on evidence-based knowledge. I often cite journal articles and evidence with patients to help them better understand my thought process in terms of diagnostic or treatment options I choose or do not choose for them. However, I do take into account patients’ experiences so I can better present plans in a patient-centered approach.

A recent article in Annals was especially relevant (1). Recently, I had seen a patient with mild iron deficiency anemia who felt like most of her symptoms could be explained by her anemia. I told her that it was possible her fatigue, lack of energy, and brain fog could be caused by the anemia, and it was important to find out what was going on and treat it. She then suggested I give her a blood transfusion.

She told me that her friend had had a blood transfusion after surgery and felt like it improved her healing. My patient felt that perhaps the same thing could work for her. I shared information about the utility, risks, and benefits of transfusion and how in her case, her anemia would not require one. That was not enough for her so I cited and shared findings from the Annals article: “Even people with moderate anemia don’t always benefit from transfusions.” After some additional discussion, she agreed to move forward with a diagnostic evaluation without a transfusion.

That experience provided an important reminder about not scoffing at anecdotal evidence. Shared experiences and advice from friends and family are the things that make each of us human, and it wasn’t completely far-fetched for my patient to think a treatment that worked for a friend could work for her. In our work as physicians, it is important to understand the sources of our patients’ anecdotal knowledge and apply evidence-based knowledge to improve it and arrive at better decisions for them.

Reference

1. Roubinian NH, Murphy EL, Mark DG, Triulzi DJ, Carson JL, Lee C, et al. Long-term outcomes among patients discharged from the hospital with moderate anemia: a retrospective cohort study. Ann Intern Med. 2019;170:81-9. [PMID: 30557414] doi:10.7326/M17-3253