Reliable Patient Information

Over the last decade, patients have been encouraged to seek out accurate and reliable health information as there is clear evidence those patients who are informed and involved in decisions about their health do better. As a result, modern NHS consultants are now being asked by the informed patient to produce evidence that they are performing current best practice i.e. evidence –based medicine or EBM (Offer and Perks 2000).

In order to assess the quality of a study, research evidence is often classified into levels 1 - 5.  Large randomized controlled trials (considered the best way to check out the efficacy of a treatment – level 1 evidence), and large prospective studies (patients who are followed up over a given time period – level 2 evidence) are types of research published in the medical literature that can be helpful in providing evidence about treatments and procedures. Reports of the experiences of individual patients or small groups usually provide less reliable evidence.  For this reason, they are classified as level 3 or 4 evidence, although these studies may still provide important clues about possible adverse effects of treatments. Any expert opinion, something that perhaps e.g. a group of cosmetic surgeons would agree on is classed as level 5 evidence.

A medical paper written by Offer and Perks(2000), both plastic surgery consultants now, explained that there is very little level 1 evidence in the plastic surgery literature and they go on to explain the reasons for this.  There are some excellent studies and information in the field of plastic surgery, but most of these belong in levels 3, 4 and 5.  For the same reasons, throughout this site, Mr Henley has highlighted particular studies where they are available (the information about breast implants is a good example).  However, some of the complication rates quoted rely on level 5 evidence - expert opinion.  Mr Henley suggests that when seeing a surgeon for a consultation, it is perhaps better to ask individual surgeons about their results and complication rates, rather than have them quote latest figures from the medical journals. Any reputable surgeon would be happy to provide you with this information.

Mr Henley also adds “Any recommendations taken from evidence-based medicine must be applied by the surgeon to the unique situation of an individual patient – there is no such thing as cook book medicine or a one size fits all”.