Speaking with your healthcare provider about treatment decisions: Q&A with a former GP

In this question & answer session, Lynda Ware a former GP and Senior Fellow in General Practice at Cochrane UK, talks about Cochrane, Evidence-Based Medicine and speaking with your healthcare provider about treatment decisions.

In a line or two, can you describe what Cochrane does?

Cochrane is a global organization dedicated to producing the best reviews of available evidence on health. Whether you are a patient, a carer, a healthcare provider, a researcher or a funder, Cochrane evidence provides a powerful tool to enhance your healthcare knowledge and decision making.

The key to Cochrane’s work is the production of systematic reviews of medical evidence. These reviews look at all the available evidence from clinical trials conducted worldwide to try to answer important clinical questions. For example, can antibiotics help alleviate the symptoms of an ear infection in children?

What is evidence-based medicine (EBM), as you would describe it to a lay person?

No matter who it is we are talking to – our GP, hospital consultant, pharmacist, physiotherapist, midwife, district nurse – Evidence-Based Medicine should underpin the discussions we have about our health.

Evidence-Based Medicine (EBM) enables us to make decisions about our health. It combines the best available scientific evidence with the expertise and experience of our healthcare providers, whilst heeding what we, as patients, consider most important in our lives.

How does the NHS rely on EBM, in ways that patients would notice?

Cochrane Reviews are used in the NHS to help make informed decisions on the best and most cost-effective treatments available. Organizations which produce evidence-based guidance and advice for health, public health and social care practitioners, such as The National Institute for Health and Care Excellence (NICE), use evidence from Cochrane Reviews to assess new and existing treatments. No matter who it is we are talking to – our GP, hospital consultant, pharmacist, physiotherapist, midwife, district nurse – Evidence-Based Medicine should underpin the discussions we have about our health.

When thinking about treatment decisions, what kind of questions should readers ask about it, in terms of evidence?

Put simply, there are three main questions that we should be asking before embarking on a course of treatment:

  1. What are my options?
  2. What are the pros and cons of each option for me?
  3. How do I get support to help me make a decision that is right for me?

It’s important to take time with your healthcare provider to explore the options available and the evidence behind them. There are reliable, evidence-based websites which can give you the information you need to have an informed discussion with your doctor. Examples include the Cochrane Librarypatient.info; and NHS Choices.

What would you say about the times when we don’t know the answer for sure? (For example, the evidence is mixed or lacking, with practice based on clinical opinion and experience).

There isn’t always high quality evidence available and that’s when we rely on the expertise and experience of our healthcare teams to guide us.

Where can readers find good, reliable information about evidence-based medical treatments?

Don’t rely on the media. We are bombarded with advice on new treatments and how to stay healthy. The reporting isn’t always accurate – sometimes it’s misleading, sometimes just plain wrong – and we need to maintain a significant level of scepticism and seek out the truth behind the headlines.

Below are some useful links:

For anyone interested in informing themselves more, online learning is freely available here which gives an introduction to evidence-based health care, Cochrane evidence and how to use it. Written from the perspective of a someone making decisions about health, and co-created with patients and carers, there are four learning modules, designed to give anyone an introduction to evidence and systematic reviews.

You can also access more learning materials, and information about learning events such as workshops and webinars, on the Cochrane Training website: https://training.cochrane.org/training.cochrane.org

Join in the conversation on Twitter with @CochraneUK and @Lynda_Ware or leave a comment on the blog.

You can also read more of Lynda’s blogs on Evidently Cochrane here and read about Lynda’s work teaching secondary school students about evidence-based medicine here.

Lynda Ware

About Lynda Ware

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Lynda is a Senior Fellow in General Practice with Cochrane UK. Her background is in primary care and she was a GP partner in rural Oxfordshire for over thirty years with particular clinical interests in psychiatry and women's health. Since joining Cochrane UK in 2014, she has visited many village halls and community centres around Oxford talking to non-medical audiences about Evidence-Based Medicine and its relevance to everyday life. With a colleague, Lynda now visits schools to meet students from Years 10 to 13 to teach about EBM and to encourage critical thinking, particularly around health care claims made in the media. She blogs about Cochrane Reviews for the Evidently Cochrane website.

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