Evidence-Based Medicine, Policy Decisions, and the Importance of Sociology in American Healthcare

• In Event: 1423 - Practice Symposium- Lightning Round on Career Paths, Transitions, and Opportunities for Sociologists Beyond Academia

Abstract

Hospital groups, private practices, and insurance companies are increasingly embracing the integrated healthcare delivery model: a system in which insurers and healthcare providers operate as unified entities to contain medical costs and monitor physicians’ clinical behavior. This unification has led to increased reliance on and admiration of evidence-based medicine (EBM) for two major reasons. First, EBM employs the language and logic of “big data” analysis – a field that has (for better or worse) become associated with impeccable validity and reliable conclusions. Second, it allows for tight surveillance by bureaucracies over patients’ healthcare histories and physicians’ clinical practices.

Sociologists have noted that physicians are often critical of EBM’s perceived infringement on the doctor-patient relationship, erosion of the “professional” physician’s status, and sacrificing of individual patient attention for bureaucratic function and ease. Patients often share these concerns; they also may be hesitant to abandon the security laden in the authority entrusted to physicians and the ritual of the diagnostic and prescriptive processes.

When crafting healthcare policy derived from “data-driven” analyses, we ought to consider these criticisms and concerns when determining how to affect physician and patient change alike. We cannot expect physician and patient behavior to be as “data-driven” as our statistical models.

I will employ concepts from the sociology of medicine and professions to argue that sociologists working in healthcare analytics ought to remember the contentions between evidence-based medicine and professional authority/autonomy along with patient perceptions of “quality care” when making data-driven policy decisions. Practical examples of real, current policy challenges (e.g. pay-for-performance programs, population health assessments, episodic care management) will be given.

- Chuck Galli, PhD. Senior Research Analyst in Informatics – Independence Blue Cross (Philadelphia)

Author

• Chuck Galli, Independence Blue Cross