2024-07-10 10:23:10
The definition of any scientific object (planet, species, storm or poverty) is based on criteria that change with time and knowledge. Medicine uses standards to make diagnoses and evaluate treatments. These criteria are almost immutable in infectious diseases or traumatology, variable in cardiology, even more so in oncology, and very fluid in psychiatry. Another complexity in medicine is the inherent nature of standards, depending on whether they are set by patients or doctors. A classic joke is that although the surgeon is satisfied with the operation, the patient dies. Instead, patients can become satisfied or cured through treatments for which no standards of evaluation exist. These two examples illustrate two kinds of activism in nursing. Theoretically perfect treatments may have no clinical effect, while esoteric treatments may be effective. Some may object that diseases treated by academics are more serious than those treated by esotericism. This objection is admissible if a diagnosis based on precise criteria was made before treatment was evaluated according to precise criteria; this is rarely the case regardless of academic or alternative practice. On the one hand, we treat underlying diseases for which diagnostic criteria are ineffective, and on the other hand, the patient’s immediate satisfaction becomes the only criterion for evaluating treatment.
In a perfect world, diagnostic criteria should be the prerogative of physicians, with patients responsible for setting standards of care. Unfortunately, impatience is at the heart of all practices. However, except in extremely rare diagnostic and therapeutic emergencies that have long been known, there is always ample time to evaluate diagnostic and therapeutic criteria.
Cancer screening satirizes these impatiences. Patients will be willing to undergo screening if they are told that it reduces their risk of dying from cancer over the next ten years. If we explained to him that this does not change his risk of death from any cause during those same ten years, he would hesitate or not understand.
However, the most relevant meta-analysis shows that both assertions are correct: screening only slightly reduces the risk of dying from the screened disease, but does not reduce the overall risk of death over the same period. There are multiple explanations and everyone has their own interpretation.
In nursing epistemology, the only valid criterion is overall mortality. All other standards are called “intermediate” or “alternative”. The vast majority of clinical trials have neither sufficient statistical power nor sufficient duration to meet basic standards.
If medicine has made significant progress in the development of diagnostic standards, we dare say that it is still in its infancy when it comes to the development of treatment standards.
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#Correct #standards #health #reasons
