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I have only positive things to say about Permission to Mother, an autobiographical account of a thoughtful mother and clinician who courageously writes from her heart, soul, brain, and personal experience; who is open to change in her views and opinions and is not guided by the safety of rules of any group or the status quo; she is guided by love and openness to the experiences life brings her and her family. Her process benefits her and those around her and those who read her words. And to add to that, the writing style and story telling ability here make it a very enjoyable read speckled with both the humor and seriousness of life. ~Laura Keegan RN FNP, author of Breastfeeding with Comfort and Joy

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Wednesday, October 22, 2008

Evidence- or Intuitive- based based care?

The standard-of-care is a legal term, the level at which the average, prudent provider, in a given community would practice. It is how similarly qualified providers would manage care under the same or similar circumstances.

The standard-of-care comes from the evidence. The evidence is what research "proves."

Personally I like forming my own opinions and I really like getting "beyond the standard of care." Are my thoughts just some random crazy doctor thoughts?

I carefully consider everything I put in writing and the advice I give to my patients in the office. What I learned in school never seemed to apply to my births and my own kids. The more and more I read, I realize I need to read opposing positions. I often find that the evidence is conflicting, out-dated, biased, manipulated, and mistakes are often made in publishing and printing the facts.

"Evidence" is what holds up in court. Despite all the problems with the evidence, few professionals can get beyond the legal aspect. They live in fear of constant law suit when they take care of patients and make recommendations. They can't be flexible.

I prefer to develop relationships with my patients and take the intuitive and individualized approach based on all the evidence available to make a recommendation. That is why the subtitle of my book is "beyond the standard-of-care." I guess I am not average or prudent. Oh-well. :/


Trish Chibas said...

And this is why we love you!

fitncrafty said...

I don't think you are thinking way out there. The clinical anecdote is imperative in your practice.
You know what you see and what works. You also know that so much of this information has NOT been studied or researched at all.
All you have to base your information on is clincal and based on your own case studies through your own data.
You probably have enough information in your files to write some really great 'evidence' based case studies.... (what a great thesis project, humm to bad I don't have a medical practice)

Lauren said...

We are ALL so honored to have you! You go above and beyond, always showing that you truly care about us. Your kindness, wisdom, warmth and "always being there" speaks volumes to those around you. These qualities are hard to come by in a doctor. Most of whom can be sterile and cold. You are one-of-a-kind!

Allana Martian said...

I echo what Trish said! Rob relayed your phone message to me. Thank you! He gets brownie points for not hanging up the phone because the kids were all yelling and following him around while he was talking to you. (hope your ears are fine!)

Looking forward to my appointment! I'm tired of my worsening thyroid symptoms!

Jane said...

Keep those "random crazy" thoughts coming! Remember that Geniuses are rarely appreciated in their own time period....

As a new patient to your practice, I am still getting to know you, but I am genuinely grateful for your intellect, insight and "outside the box" critical thinking. Thank you for taking a stand for Mothers who parent with their instincts and intuition as well as their intellect. It is hard to swim upstream against tide of traditional dogma. Thank you for providing anchors along the way to help us give our children the best care possible.

Red said...

And this is why you are our Doctor now!!

Brianisarockstar said...

As someone who did a lot of data maniputlation to prove medical based theories (before I became a Rockstar) I can tell you without a doubt that research studies are produced with bias. Usually the person writing the piece manipulates the backing data to exact a dataset that backs their opinion. That opinion is then sold to the vendors in the form of "articles" based on facts, thousands of reprints are created, the vendor hands them out everywhere .... markets around them and the next thing you know ... Joe Anybody is beliveing this garbage.

This is not for you but for everyone who reads your blog ALWAYS do your own research. You are probably not the one making $$ on it, but rather depending on it to help you.

Intuitive based all the way ...

Did I mention I get a little passionate about how messed up our system is ... don't even get me started on group purchasing organizations, insurance orgs, etc

Wife to the Rockstar said...

I am with Trish. This IS why we love you.

Mama K said...

Thank you for putting this into words. I am a doula and every time I read of the push for "evidence-based care" I think, yes, that's good as long as the evidence says what we want it to say, right? Sometimes the evidence is right on, sometimes it isn't. I think knowing the studies, and then knowing when to make exceptions, and above all, knowing the person in front of you... all that is important. I like the way you think. It would be great to do my own research, but it is just not feasible. But I do have common sense and intuition.

I wish I could get my hands on a copy of your book. (-:

Permission to Mother said...

Mama K, You are absolutely right, when the evidence fits we tend to use it. A week later the SAME authority comes out with evidence that doesn't suit or needs and we throw a fit. As providers we need to be critical.

Everyone else, Thank you for all the love. You guys are my favorite patients! :)

Tammie said...

I know I have said it before but man we need a Doctor like you in EVERY city! Thank you so much for not being afraid to think outside the box! Keep up the great work!

Annie said...

I'm for intuition all the way. I really think intuition is often guided by the Holy Spirit.

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