Pragmatic Controlled Trials
Our current discussion is examining the resilience of the hypothesis that there will be hardly any Randomised Controlled Trials (RCTs) in about 5 years, as these will not adequately reflect the reality of care. Instead, alternative study designs are now available, of which Pragmatic Controlled Trials are a central option. The members of the ICE are invited to participate in the discussion of this hypothesis (External Link).
Our current discussion deals with the connection between objective risks and their subjective perception, which we call "perceived safety". Understanding the relationship between objective risk and subjectively perceived security explains the demand behaviour decisively. In an efficient health care system, it should be understood that diagnosis or therapy should only be carried out if it can reduce either risks or their consequences (i.e. illness or premature death). As a rule,"perceived safety" should not be the only thing that leads to an indication. Since professional communication is the most important modulator of this construct, the professionalization of risk understanding and risk communication in the health professions is central. The topic of "perceived safety" has a broad social significance with regard to over-, under- and wrong supply (External Link).
Professional Communication and Efficient Supply
A critical doctor should be able to answer the following questions: What do you recommend for screening, diagnosis and therapy? Why exactly these measures? How many patients have their health problems been corrected without these measures? And finally, how many patients could the health problem not be solved with the measures applied?
Relevant reliable data must be available for this purpose, which can be obtained, for example, by means of Pragmatic Control Trials.
And healthcare systems and their physicians must learn to communicate effectively. Scientific data confirm that professional communication can prolong life.
Effective and customized communication is more important than ever, especially against the background of patient empowerment, shared decision making and patient-centered care. A health care system will only become efficient if patients have the answers to these questions.