“You won’t fool us”: how to evaluate the recommendations of a doctor without a medical education

 In the past 5 years, the number of clinics and doctors practicing an evidence-based approach has grown significantly in UK. What is its essence.

With an evidence-based approach, the specialist chooses the safest and most effective type of diagnosis, treatment or prevention, based on scientific research. However, until now, not all doctors adhere to the principles of evidence-based medicine. Therefore, sometimes outdated or unnecessary medicines and examinations are prescribed for a particular person . If the recommendations of the doctor cause you doubts, it is better to play it safe and get a second opinion from another specialist. How can a person without a medical education understand that “something is not right” was prescribed.

Believe no doubt

It is difficult to be a competent evidence-based doctor, because he needs to keep up with science, know foreign languages, and be aware of current medical news and discoveries. And for this you need to constantly monitor international scientific sources and resources (Pubmed, Up to Date, Cochrane library, Medscape) and be able to read research. When prescribing treatment, in addition to established protocols, the doctor should take into account high-quality scientific research, international guidelines and recommendations, because the protocols are not always updated on time, and in some you can find ineffective treatments, for example, ineffective antiviral or dummy drugs.

But the reality is that there are not so many evidence-based doctors today. Therefore, you need to carefully approach the choice of a specialist and pay attention to some markers. Each specialty has its own, but there are several common points.

1. Unreasonable appointments

You should be wary if the doctor uses the following techniques.

• Prescribes immunomodulators and antivirals. To date, only drugs against herpes and influenza viruses have a good evidence base. Studies on influenza are constantly updated, but so far only two are considered effective. Although the scientific community is also arguing about them. As for antivirals for the treatment of colds and SARS, firstly, each virus has a lot of strains, and they constantly mutate. One drug cannot work against all of these strains. Secondly, the virus lives and multiplies deep inside the cell, and a safe dose of an antiviral drug is not able to penetrate there. Thirdly, the evidence base for these drugs is highly questionable. If the drug does not have large studies, then it is impossible to talk about its safety.
• Recommends a course of dietary supplements instead of dosage forms of vitamins. Dietary supplements, unlike dosage forms of vitamins or drugs, do not undergo proper quality control. They have it rather simplified, it does not take into account many criteria. For example, a manufacturer may indicate one composition on the label, but no one strictly controls this composition.. As a result, it is not known what was actually put in the jar and in what dosages.In addition, long-term use of various dietary supplements can lead to liver pathology. There are already sad stories associated with course intake of dietary supplements.
• Prescribes homeopathic treatment. Homeopathy involves the treatment of like with like in very small concentrations. For example, antibodies to some specific protein or plant extracts are taken and diluted in a large amount of water. So a medicinal solution or tablet may not have an active substance at all. But adherents of homeopathy believe that water has a memory, and the effect is achieved due to the memory of water in which extracts or antibodies were dissolved. In fact, the maximum that can be obtained from a homeopathic remedy is the placebo effect . Therefore, if you treat serious diseases with homeopathic remedies, you can lose time and get complications. 
• Prescribes mucolytics to children under 5 years old, often without reason. Such drugs are not recommended for young children, because they thin the mucus, increasing its volume. Sometimes it is difficult even for an adult to cough up a large amount of mucus, not to mention a child. Therefore, mucus accumulates in the lungs, which can lead to pneumonia.
• Prescribes nootropics. Most nootropics have not received evidence of effectiveness, and most importantly, safety. There are nootropics that are completely banned in a number of countries, because they led to serious health problems.
• He prescribes antibiotics for no reason. For example, many recommend drinking antibiotics, taking into account only one symptom (prolonged temperature), while not taking into account the patient's well-being and not prescribing the necessary tests. Antibiotics work on bacteria, but not on viruses. If the infection is viral (such as the flu), then antibiotics simply won't work. But in our country, antibiotics are often prescribed for viral infections. Yes, sometimes a viral infection can be complicated, that is, a bacterium joins it. But even in this case, before prescribing antibiotics, the doctor must confirm his suspicions both by assessing the symptoms and by instrumental/laboratory studies and tests. Unreasonable use of antibiotics leads to resistance of bacteria to antimicrobial drugs. This is already a global problem that the World Health Organization has taken on. Resistance to antibacterial drugs is dangerous because when there is an indication for the use of a particular antibiotic, it simply will not work. That is, the bacterium that caused, for example, acute cystitis in a person, will be insensitive to the antibiotic.

2. Inability to communicate with the patient 

It is necessary to pay attention to how carefully the doctor collects an anamnesis: whether he asks about the patient's condition, whether he listens to complaints, whether he conducts a complete examination. For example, pediatricians or therapists often do not palpate the lymph nodes and abdomen , do not examine the ears. Some doctors prescribe serious treatment right away, without adhering to observational tactics. They focus only on the results of tests, not taking into account the symptoms and well-being of a person. Therefore, if the doctor does not take into account the opinion of the patient, does not establish a trusting contact, presses with his authority, it is worth looking for another specialist.

Is it safe to follow these guidelines? 

The consequences of prescribing a doctor of non-evidence-based medicine can be absolutely different. It all depends on what diagnosis the patient has, what recommendations are given by the doctor and for how long.

For example, if a neurologist prescribes a massage to a six-month-old baby for no good reason - and often there are none, then he may not improve, but also not worsen the child's condition. Although many children and parents, this procedure delivers considerable stress . 

Another thing is if a patient with an oncological disease was prescribed a long-term intake of dietary supplements. Such a “treatment” can do great harm and lead to sad consequences.

How to be a patient

Whereas a physician has access to scientific literature and international sources of medical information, access to patients is limited. Therefore, everyone needs to deal with at least the basic issues of treating ARVI, dispel myths about nutrition and the effectiveness of dietary supplements. Health is very important. If you want to be treated and not take useless drugs, you will have to spend time studying the information. You can read reviews about doctors in independent authoritative sources, search for doctors on social networks, read their posts, ask questions. Doctors who adhere to the principles of evidence-based medicine usually have information about this. 

The main advice is not to self-medicate and find a competent modern specialist, ask him for a second opinion and find out how safe and effective the treatment is for you.