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How can I make sure my medical workers are using evidence based medicine (EBM)?

DNA Thief

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I originally posted this on skeptics.stackexchange.com, but it's not a question suited to the site. So I'm trying again here.

My wife and I recently found out we're expecting.

While looking into a hospital for the delivery, I found that all the hospitals in my area use midwives for the births that are likely to be uncomplicated. There's doctors on standby for emergencies.

I'm a bit concerned after reading this paper which suggest that 93.9%(!) of midwives recommend CAM.

So, which leads me to the question - how can I make sure the medical professionals that I'm dealing with are actually using evidence based medicine and giving me evidence based advice/care?

As a secondary question, do I have the right to ask for a doctor from the start? I live in Australia.
 
You could always try talking to them. It's my impression that most medical professionals will discuss medical treatment options with their patients, if their patients ask.
 
If you live in Australia, do you have private health insurance? If so then you should be able to choose your doctor. But you need to ask and ensure everyone is on the same page.

I also agree with theprestige. You need to ask. What sort of CAM do they use and for what reason? If they only use it because the patient asks for it then you can tell them you do not want it. But if they try and push it then you need another midwife. I assume that you and your wife (have you asked her?) do not want CAM.
 
I should have reworded my post - SE prefers questions with 'singular' answers. My bad.

I'll be asking the medical personnel directly, sure. My main concern is wasting too much of their time - the waiting rooms are always packed around here. So, a better question may have been 'Is there a simple question I can ask' or 'Is CAM a recognised term in healthcare'... I know I'll have to ask quite a few people in the near future too, so simple helps.

We're on private health, and both on the same page when it comes to CAM.
 
Aussie health sounds weird.

Health care in the US (for those of us lucky enough to have it) usually involves a primary care physician who is paired with you for all your general health needs and questions. It's usually the same person for years, unless you change providers or just decide to go with a different PCP.

Anyway, the first step in any planned or expected specialty care situation would be to make an appointment with your PCP (you should be seeing your PCP about twice a year anyway). You can talk to them about your specialty needs and concerns, and they should be able to recommend one or more specialists who will be able to meet your needs.

Then you meet with the specialist, discuss your concerns, and satisfy yourself that they will, in fact, do what you want.

Ideally, you start this process far enough in advance that you have time to get a second opinion if you don't like the first one.

In this particular case, I suppose you'd ask your PCP to recommend a hospital or clinic with a good birthing staff, and probably also recommend an obstetrician or similar with whom you could schedule a consultation. Presumably a competent obstetrician would understand your concerns and recommend an appropriate hospital. Or they could introduce you directly to the appropriate hospital staff member(s) to consult with you.

I mean, yours seems like the kind of question that would be best answered by consultation with a specialist, rather than by loitering around hospital waiting rooms buttonholing duty nurses or what have you.

Assuming that's what you're doing. If you're just worried about wasting a specialist's time with your questions, don't be: That's what they're there for. I don't know how private insurance works in Australia, but in the US, you'd be paying a premium for the privilege of consulting with specialists about your health needs and concerns. You bought it--you might as well use it.
 
From what I can tell, the main difference is our universal health care system (medicare). Other than that, what you described is very much the way it works here too. The main advantages of private health cover here are not having a 3 year waiting list for specialists, and usually a mildly better (sometimes private) room for hospital stays.

We've got no choice on the hospital. We found out very late, and they're booked out fast around here.

I'm not worried about wasting a specialists' time, no. I'm do worry about wasting the taxpayer funded GPs (PCP) time - they're the ones with the busy waiting rooms.

We're already seeing an obstetrician, so I'll make sure to bring it up on our next visit.
 
DNA Thief said:
I'm a bit concerned after reading this paper which suggest that 93.9%(!) of midwives recommend CAM.
Click to expand...

That really does seem high. I wonder how much of that is simply meeting market demand as opposed to actively advocating for woo.

Also, what degree of CAM? Its one thing to light a scented candle and dim the lights to help put a patient at ease while evidence based medicine does its thing. Its quite another to insist on performing acupuncture and administering colloidal silver to treat a hemorrhage because Western medicine is evil.
 
I'm guessing the number's so high due to the area and, as you say, market demand. There's a few other papers on the subject online, but behind paywalls.

I agree that the degree of CAM makes a difference, but I'd prefer none. Me being me, I'll worry about say, the untested effects of airborne (burned?) perfume.
 
I suggest that you try to get medical professionals that use results that are based on the evidence, but not based on what has been called by the proper name of Evidence Based Medicine. There is an important difference.
 
What is CAM? It's not an acronym I am familiar with.

Why not let the Midwives do their jobs?
Apart from a birth with complications I can't see why a doctor is needed at all.
 
Captain_Swoop said:
What is CAM? It's not an acronym I am familiar with.

Why not let the Midwives do their jobs?
Apart from a birth with complications I can't see why a doctor is needed at all.
Click to expand...

http://www.medilexicon.com/medicaldictionary.php?s=complementary+and+alternative+medicine


complementary and alternative medicine (CAM)
a term referring to a heterogeneous group of hygienic, diagnostic, and therapeutic philosophies and practices whose principles and techniques diverge from those of modern scientific medicine.
Click to expand...
 
Captain_Swoop said:
So CAM is the same as a lot of mainstream medicine then?
Click to expand...

You're cute.

CAM primarily consists of a wide variety of "treatments", including, but most certainly not limited to, homeopathy, aromatherapy, healing prayer, acupuncture... you know, the sorts of things that, if they were actually effective, would just be called "medicine".
 
Welcome to JREF DNA Thief! :) Sorry that the question got closed at Skeptics.StackExchange, but you are right, it didn't fit the format of the site. However, if you have alarm bells go off about a specific claim you hear from a doctor, feel free to ask that on the site (assuming there is a way to verify the noteriety of the claim). Yeah, gotta have those rules in place, otherwise it will devolve into a Yahoo!Ask type site. :)

And to remain on topic and oblige Mojo: http://www.timminchin.com/2011/04/08/storm/
 
DNA Thief said:
I should have reworded my post - SE prefers questions with 'singular' answers. My bad.
Click to expand...

No, SE prefers questions that challenge a specific claim. Not a "What do I do" type of question. For instance, if you asked something like "Is it true that 93% of midwives reccomend C.A.M. practices" and then cite the hand out, that would be a perfectly acceptable question.
 
Thanks for the welcome Larian. I have been lurking for a while though. :)

The "singular answer" bit referred to SE as a whole, not just the skeptics subsite. You're quite correct about needing a specific claim for skeptics.SE - unfortunately, I only figured that out after posting the question. You live and learn.

Good choice with 'Storm', one of my favourites. :)
 
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