The Wise Practitioner vs the Influencer Clinician
Save as PDFI’ve recently developed an allergy to the phrase “game changer.” It is one of the most overused phrases in marketing. It seems that every new app, exercise routine, and household product is a game changer. It is used so often now in every new marketing campaign that I wonder, “if everything is a game changer, is anything really a game changer?”
My annoyance with this phrase isn’t just the ubiquity of its use in a marketing and consumer-driven economy. My annoyance stems from when that consumer-oriented phrase gets adopted for any new treatment or technology in medicine. When consumerism spills over into medicine and doctors start treating patients based on hyped-up marketing narratives and fluff from commercial jargon rather than scrutiny of the evidence, it weakens our credibility. It reduces us and our profession from evidence-based, wise practitioners to influencer clinicians more at home on social media than in the exam lane.
So how do we, as clinicians, not only choose technologies and treatments for our practices but also decide them for our patients? If you’ve read any of the previous columns here at “Follow The Science” it will be no surprise to you that the answer is evidence-based medicine. David Sackett, the so-called father of evidence-based medicine, defined it as “a systematic approach to clinical problem solving by the integration of the best research with clinical expertise and patient values.” In other words, we make wise clinical decisions for our patients by filtering those decisions through the best research, clinical expertise, and patient feedback. This framework not only helps us reduce uncertainty in clinical decisions, but it can also be helpfully extended to appraising new technologies and treatments as we add them to the armamentarium of our practice.
When we apply the three pillars of evidence-based medicine to new products, each pillar functions like a filter.
- First, the research pillar: What does the evidence actually show? Are the improvements both statistically and clinically meaningful? What is the absolute risk reduction or number needed to treat? Do outcomes replicate across studies, or is the enthusiasm driven mostly by marketing momentum?
- Second, clinical expertise: Is there a coherent physiological explanation for why the treatment should work? Does real-world experience align with the theoretical mechanism? Are the outcomes we see in practice proportionate to the claims made in advertisements?
- Third, patient preferences: Do patients value the treatment enough to tolerate cost, side effects, and practicality? Is adherence realistic? A treatment can be scientifically valid yet still fail because patients don’t actually want it.
The more a new technology satisfies all three pillars, the more confidence we can have that it meaningfully improves care and maybe, just maybe, we consider calling it a “game changer.” Take optical coherence tomography in glaucoma management. If anything deserves to be labeled a true “game changer,” OCT would come close, precisely because it satisfies all three pillars.
- Research: OCT has a robust evidence base demonstrating structural progression long before functional loss.
- Clinical expertise: The physiological rationale is straightforward: retinal ganglion cell complex loss precedes visual field change and OCT quantifies that loss objectively.
- Patient preferences: Patients value clarity. They appreciate visual explanations of their disease, and adherence to follow-up improves when they can see change rather than simply hear about it.
OCT didn’t become essential because it had good marketing; it became essential because it passed the evidence-based test across all three dimensions of decision-making. In that sense, OCT represents what a true practice-changing technology looks like. Compare that with the newly approved presbyopia drops (pilocarpine 0.4% and aceclidine 1.44%), which have been promoted with the kind of “game changer” language now common in consumer advertising.
- Research: The clinical trials are promising, with a low NNT and a mechanism that makes physiological sense.
- Clinical expertise: Early adopters are cautiously optimistic, but real-world data is not yet as robust as information we have from RCTs. We still don’t fully know how patients will tolerate the side effects, particularly the redness (aceclidine), dimming of vision, and headache.
- Patient preferences: This pillar is still uncertain. Some patients will accept the tradeoffs; others will try it once and decide the ongoing cost-benefit ratio doesn’t justify continued use.
For now, the treatment is interesting, maybe even useful, but it is not yet clear whether it rises to the level of a game changer, at least not in the evidence-based meaning of the term. I hope it does, but for now, let’s save that phrase for something that does really change the game.
What about a treatment category that has clearly not changed the game? Some may hate me for this, but I’d include most dry eye treatments, including drops, lid therapies, and nutraceuticals, in that group. (Disclaimer: Dry eye management is one of the main pillars of my practice.) Nearly all these interventions have, at one time or another, been promoted as “game changers” or some similar hyperbole.
Yet when filtered through the lens of evidence-based medicine, the results have been far more modest. The research signal is often real but small, clinical experience reveals incremental rather than transformative improvement, and patient preferences are frequently limited by cost, burden, and adherence.
Yes, my patients are better off than they were ten years ago because I do use nearly every FDA-approved and off-label therapy from the past decade. But from a purely clinical experience standpoint, topical loteprednol may be the closest thing we’ve had to a true game changer in ocular surface disease.
This measured and cautious approach is what I’ve previously described as the mindset of the Wise Practitioner. The Wise Practitioner resists the gravitational pull of hype and instead filters new technologies through the steadying pillars of research, clinical expertise, and patient preferences. The Influencer Clinician, by contrast, moves quickly, speaks in superlatives, and adopts the language of consumer marketing. Our patients deserve better than buzzwords. They deserve decisions anchored in evidence, humility, and clear communication about what we know and what we do not.
Dr. Klute owns and practices at Good Life Eyecare, a multi-location practice in Eastern Nebraska and Western Iowa. He is a fellow of the American Academy of Optometry and is certified by the American Board of Certification in Medical Optometry. He writes and lectures on primary eye care practice management, evidence-based medicine, glaucoma, and dry eye disease.
