Dr Siegel discusses the need to combine evidence-based medicine from guidelines and research with clinical experience and patient preferences to achieve the best outcomes for patients with Crohn's disease.

Corey Siegel, MD, is section chief of Gastroenterology and Hepatology and the codirector of the Inflammatory Bowel Disease (IBD) Center at the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire and a professor of Medicine and of The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth.

TRANSCRIPT:

Hi. I'm Corey Siegel from the Dartmouth Hitchcock Medical Center, and I'm coming to you from the Crohn's & Colitis Congress in Denver, Colorado. I was honored to open the meeting with a talk about balancing evidence-based medicine and the art of personalized Crohn's disease management. I thought this talk was an important start to the meeting to really think carefully about what evidence we have when we think about day-to-day decisions with our patients with Crohn's disease and ulcerative colitis.

While we have a lot of clinical trial data, we have over 100 different guidelines to talk to us about how we should manage patients. It's rare that an individual patient fits into that specific circumstance. In fact, a study out of Mount Sinai a number of years ago looked at all the patients that came through their clinic on biologic therapy, and only about 30% of those patients would've qualified for any clinical trial that used biologics to treat patients with inflammatory bowel disease.

Therefore, we have over two-thirds of patients that were relatively unstudied in these big clinical trials, and these are the patients that are coming through and we're seeing in the clinic. So while the evidence is important and we need to use it as a guide, what we really need to do is combine it with our clinical experience over time. And of course, that grows and grows as you see more patients and learn from your patients.

So a modern day definition of evidence-based medicine is really taking the literature, but putting it in context with their clinical experience, the patient's circumstances and preferences, and also the practice environment. Are you going to be able to get that medication for a patient in a timely manner? So really, as your career evolves, you're constantly turning the dials of how much clinical experience you put into your decisions, how much you rely on or question the evidence, and how you learn from and understand what your patients need.

And really, as you become a particular type of gastroenterologist throughout your career, that might evolve as the data changes, as you learn more, and as you feel more comfortable in certain circumstances. So again, evidence-based medicine is critically important, but you can't rely on it completely because it never applies perfectly to your patient. We’ve had incredible variation of patients with Crohn's disease and ulcerative colitis.In fact, there are probably hundreds, if not thousands of variations when you think about all of the different variables that plant our decision-making: age, gender, time with the disease, prior exposure to medications, prior operations that they've had. So you need to think about those variations, think about the literature, put it together with your clinical experience, and make the right decision for that individual patient sitting in front of you in clinic. It's been a great congress here, and I hope to see you at the next one.