It's Playoff Time: Put Non-Evidence-Based Care On The Sidelines

The NBA and NHL playoffs are upon us. This is the time when teams are looking for consistency, team work, and results. It is the time when your big money players need to shine, and your situational players need to step up at crunch time.

Non-evidence-based care (NEBC) is a big-name player in the starting line-up of health care. It gets a lot of minutes of game time. It makes a lot of money as a player, making it a significant draw on the team's salary cap. Sometimes it works, sometimes it doesn't.

With that in mind, let's send non-evidence-based care to the sidelines, once and for all. Here's how we might do it.

If this was professional sports, a number of stakeholders would be involved to refine the overall quality of the game. It would require a concentrated effort from the league, the coaches, the general managers and owners, the player's association, the players, and the fans:

1. League: The league sets the rules for anything related to the game - from rules to marketing.

This is much like professional licensure. Imagine if professional licensure exams no longer tested graduates on NEBC. If you don't test it, there is no "need" to learn it. The rules of the game would help define the use (or absence) of NEBC. 

2. Coaches: The coaches define the game plan for the players. They educate. They guide. As an example, if the pick-and-roll was illegal in basketball, would coaches teach it?

Health care educators serve a similar role. If there is no need to "learn" NEBC, then there is no need to teach it. Educators could then marginalize NEBC procedures by simply not teaching them or by promoting critical thinking over "test taking".

3. General managers and owners: The owners pay the salaries, and the general managers help to select the players to be paid.

If you are a third party payer, just make the choice to no longer reimburse for NEBC anymore. There is enough research on scientific plausibility to establish a foundation for payment (or not). And I can almost guarantee that if there is no reimbursement, there will be little desire to use it.

4. Player's association: The labor organization is responsible for promoting the collective interests of the players. It can also be involved with monitoring the standards and behaviors of the players that are members in the association.

Professional associations represent clinicians and their profession. Most, if not all, have an ethical component built into membership. Associations could simply decide that NEBC is no longer an acceptable standard of care - and monitor the standards of membership accordingly. If you have a code of ethics, stand by it.

5. Players: The players are the ones making the plays and providing the product for the fans. They are also subject to the league rules and standards. For example, if "flopping" is a penalty, will players continue to do it? (assuming, of course, that the rules are maintained consistently). Sometimes it is asking a lot of the player to do what is right for the game. Some get it, some don't.

The same is true for clinicians.Clinicians could marginalize NEBC by simply choosing to no longer offer it. The choice exists for the clinician to do what is right for the profession and for the patient. Some get it, some don't.

6. Fans: The game and its fans are the reason why the players exist. The fans are the consumer. They become more educated in terms of what a good product is, what a good player is, what good basketball or hockey really looks like. It's not fighting that gets you to the Stanley Cup, it's play-making.

Patients must be educated on the value of clinical guidelines, not as "limiters to care" but as "guiding you to the best care". They need to be educated in that which is science-based versus that which is no better than sham or snake oil.

Build it, and they will come. If you create a demand for a good product, then there will be a supply of it. You don't see professional basketball or hockey teams bringing lousy product into the playoffs. The best teams thrive. Health care should be no different.

Let's put non-evidence-based care on the sidelines. Put the pros on the court or the ice, and give the fan a good product and good value. Science-based care is good for some great playoff performances, and maybe even a Stanley Cup or two.

Photo credits: StanleyCupYosemiteVisit

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