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Evidence-Based Medicine

Evidence-Based Medicine

by Danielle Ofri

We were at the end of our visit. We’d done the full history and physical exam. We’d reviewed the status of Ms. R’s diabetes, checked her blood pressure, adjusted her three diabetes medicines, reviewed her cholesterol levels, written out all the prescriptions, arranged appointments for the eye doctor and the nutritionist. Every few minutes I turned from her to the computer to type notes of our conversation so that I’d have appropriate documentation of our visit together. I’d checked to see how her kids were doing and how things were at work. Now we had two minutes left of our allotted fifteen minutes to review “health maintenance.” I quickly reviewed the status of her vaccinations, the date of her last Pap smear, discussed the importance of regular exercise, use of sunscreen, five servings of fruits and vegetables per day. Now there was one minute left.

“What about a mammogram?” Ms. R. asked.

Recently, a memo had been sent to all of the physicians in our department, reminding us that mammograms were one of the “Performance Indicators” that regulatory agencies use to monitor our hospital’s quality of care. “We realize that the controversial data regarding mammograms for women aged 40-50 are not resolved,” the memo said. “However, we urge you to order this important screening test for all your patients over the age of 40.”

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About the Author

Danielle Ofri’s is a physician at Bellevue Hospital and an associate professor of medicine at N.Y.U. School of Medicine. She is also editor-in-chief of the Bellevue Literary Review.

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