Evidential discrimination on pain management
"A delusion is something that people believe in despite a total lack of evidence."
What is evidence? The answer could be the various types depending on culture, region, laws, ethnicity and personal belief or thoughts. But in the sector of health issues, most probably we all human beings have a piece of common ethical evidence. When in Bangladesh the medicine Paracetamol is used to treat fever and pain then its pathophysiology would be the same if we use it to another place like Canada or Australia. That's why we all the medical professionals read the same type of textbooks all over the world. But it's not the solution as all in one.
To understand the problem, to seek the knowledge and to find out the solution we all the professionals still remain in the same line and that is "the research" and "the journal publications" and it also has a great impact on these evidential approaches. The evidence-based movement was given a further boost when Sackett established the Center for Evidence-based Medicine at Oxford with the establishment of NICE in 1999. Research is only one of several knowledge sources but policymakers have goals for other effectiveness and efficiency.
They are often driven by ideology, political motives & others. But, an evidence-based approach for clinical and public health practice, healthcare management and healthcare policy should be informed by scientific evidence. As soon as if we realize it, we can success upon it.
Now, we are in the business with symptom relief, not symptom prevention. Let's jump to the detail into it. Undoubtedly, we could say that-this is the era of mechanical pain. We already crossed over our antibiotic limit and on the other hand, we now stand in front of the risk of painkillers and steroids.
From the thought of overuse or misuse of those drugs every time we fell satisfaction to blame the illiterates and non-conscious peoples, but the fact is - "the world will not be destroyed by those who do evil, but by those who watch them without doing anything" & that's why most doctors don't want to know you about the 3rd leading cause of death is "preventable medical error". According to the Johns Hopkins study, more than 250,000 people in the US die every year from medical errors.
Other reports claim the numbers to be as high as 440,000. So, think about our country? Not only the unauthorized pharmacy or false doctors is the quack but the physicians and practitioners also do the same thing by supporting their malpractice, unskilled prescribing & avoiding the proper referral system.
So, why it would be wrong if anybody likes to call them quack also? From that view, there are lots of physicians beside us who do the practice like a quack and inspire the quack-ness. Sometimes these quack physicians can't tolerate any allegation against himself and try to create a concept that only his/her degree gives them the right to make all personal-self-evidence is true. But the universal authenticity is "power is not sufficient evidence of truth" and "intolerance is evidence of impotence".
As well as we know "Leading by example is the most powerful advice you can give to anybody", so let's discuss some evidential example now. Low Back Pain (LBP) - the most leading cause of disability and 90% of these cases occurred due to Sciatica/PLID. Disability - According to the Ministry of Social Welfare, near about 17 million disabled exist in our country. There are more than 14 million geriatric people and most of them have experienced pain, paralysis and disability. Spinal Cord Injury (SCI) - Approximately 1 million people have suffered Paralysis due to SCI and every 3 people out of 100 are the handicapped one due to the Road Traffic Accident (RTA).
STROKE -according to the latest WHO data published in 2017 death due to stroke in Bangladesh in 16.27%. Joint pain-Everyone people out of 3 suffered from joint pain and arthritis is now the second major disease after fever in Bangladesh. These types of data are not to be ended by only one article. The main aim is to figure out the proper healthcare solution and treatment for these upcoming new variety types of problems.
According to recent and updated evidential medical sources, research and databases, physiotherapy and Rehab is the 1st mandatory best treatment for these health hazards. But even then health professionals and policymakers are not so concerned to remodel the traditional treatment method and management to work under an umbrella. When our motto should be "Treatment under one roof" we forget the importance of physiotherapy into the general healthcare sector, hospital& ICU, sports, geriatric, rehab sector, NGOs, special childcare & schools and in education.
Though the mainstream education system for health professionals is MBBS, BDS, Rehab Practitioners (BPT, OT or SLT), BUMS, BAMS, and BHMS now, unfortunately, till now we are not able to make an independent specialized institution or college for this noble of physiotherapy and Rehabilitation. The Evidence-based approach in healthcare has required the creation of supporting evidence infrastructures. The US already started this method and the "Agency for Healthcare Policy and Research (AHCPR)" was established in 1989 to enhance the quality, appropriateness and effectiveness of human health.
To the development of a truly "learning health system" active and continuous participation in the creation and application of research-based knowledge is viewed as essential. We already crossed 50 years but we the health professionals can't realize the importance of this mainstream evidential treatment method with an independent college nor we can give a proper value of the dream of the father of the nation When there is no way instead of physiotherapy and rehabilitation for the upper conditions, even then some physicians try to mislead the patients & skip their appropriate referral system. It is not only harassment but wastage of - time, health status, economy & manpower of a country.
However, the aim of the treatment is not only to cure the patient for a while but it is related to community, country & obviously for the future existence. For our own evidence-based healthcare decision making, we also need economic evaluation based on Cost-Benefit Analysis (CBA), Cost-Effective Analysis (CEA) & Cost-Utility Analysis (CUA). In Bangladesh unethical or unreasonable costs for treatment purposes is increasing day by day and now it is 16.73%, as stated by the Bangladesh Bureau of Statistics. The main aim of CBA, CEA & CUA approach is for a reasonable minimum amount of cost, proper health services with satisfaction & economical confidence.
The exact referral system and the right of the physios as a First Contract Practitioner (FCP) could minimize the imbalance in the health sector and can keep a great value on the global economy and the country. On the report of the National Health Society (NHS), the proper First Contract Practitioner (FCP) system has the following benefits: 1) quicker access to the treatment, 2) reduce the workload on the GP's, 3) reduce costs - reducing GP waiting times, 4) increased emphasis on self-management & reduction in inappropriate referrals.
Lastly there is a question - "is modern medicine killing you or saving you?". So, now it's time to understand - what is actually the true healer for our health and health care system? That's all.
The writer is a Health professional, BGC Trust Medical College & Hospital, Chattogram