Evidence‑based guidelines are foundational to modern medicine. They provide structure and consistency, as well as a starting point for care. But as many medical leaders know, real patients rarely fit neatly into a box — especially when age, chronic conditions, and personal priorities complicate things.
That tension sits at the heart of a recent MGMA Insights Podcast episode hosted by Daniel Williams, senior editor at MGMA. His guest, Brian Gietzen, MD, medical director at Legacy Medical Group, describes a care philosophy his practice calls benefits‑based medicine — an approach designed to move beyond rigid interpretations of clinical guidelines and toward decisions rooted in evidence and patient goals.
“We always say guidelines are a wonderful place to start,” Gietzen explains. “But too often, they’re also where care starts and ends.”
When Guidelines Fall Short
Like many internal medicine practices, Legacy Medical Group relies on guidelines to inform care. But Gietzen has seen firsthand how standardized recommendations can unintentionally narrow conversations rather than open them — especially for older adults, who make up a large portion of the practice’s patient population across southeast Michigan.
Guidelines are often based on studies conducted in younger or healthier populations. Applying those recommendations wholesale to patients in their 70s to 90s may not account for differences in risk tolerance, life expectancy, or personal priorities.
As Gietzen said, “I’ve yet to find a scenario in life where a one‑size‑fits‑all approach fits everyone.” This realization prompted a deeper shift in how his team frames medical decisions — one centered on curiosity and a deceptively simple question: How well does it work?
Reframing the Conversation Around Benefit
This question may sound obvious, but Gietzen argues it often goes unasked — or unanswered — in everyday practice. Instead, conversations drift toward surrogate measures: lab values, thresholds, and compliance with screening schedules.
An example of this, Gietzen shared, is cholesterol management. Treatment discussions frequently center on achieving a target number, but lowering a number isn’t the same as improving an outcome.
“The question we really need to answer is, how well did we prevent a heart attack?” Gietzen clarified. Without that context, it’s easy to overestimate what has actually been achieved — especially when lifestyle risks remain unchanged.
By grounding recommendations in tangible outcomes, Gietzen explained, clinicians can help patients understand not just what is being suggested, but why — and what difference this is likely to make.
Making Clinical Evidence Meaningful
Rather than overwhelming patients with data — or relying on authority alone — Gietzen’s approach focuses on understanding the relevance of the evidence itself. His team looks closely at what a study actually measured, whether the population studied resembles the patient in front of them, and whether the size of the benefit justifies the trade‑offs.
This context allows physicians to move beyond blanket recommendations and toward more honest discussions about uncertainty. “It really does allow [patients] to become active in the decisions in their care,” Gietzen notes.
Many patients want clarity over reassurance, especially in areas where medical messaging can feel confusing or even fear‑driven.
Rethinking Preventive Screenings
Screening recommendations are one of the most common sources of patient anxiety, particularly as guidelines shift toward younger ages or more frequent testing.
Colon cancer screening is a prime example. Many patients arrive assuming colonoscopy is the only responsible choice, without understanding the relative benefits of different options — or how those benefits compare to doing nothing. At Legacy, Gietzen explains, screening conversations start by defining a goal, which is straightforward: preventing death from colon cancer.
Once that’s clear, it becomes easier to discuss how various options perform against that benchmark. Colonoscopy, stool‑based testing, and no screening each carry different levels of effectiveness, risk, and burden. Not every patient values those trade‑offs the same way.
In more traditional, guideline‑driven environments, patients who hesitate or decline screening can feel pressured or judged. In contrast, benefits‑based medicine makes room for individual preference without abandoning clinical responsibility.
“When we’re able to talk within that context, we’re able to give people information so they can make a decision that reflects their interests,” Gietzen said.
Navigating Vaccines in a Noisy Information Environment
Few areas of medicine illustrate the need for careful context better than vaccines. Post-COVID, patients often arrive with strong opinions shaped by media coverage, advertising, or social conversations. Rather than countering opinions with opinions, Gietzen aims to reset the conversation around information.
“I always say my first goal is that patients have no idea what my personal beliefs are on vaccinations,” he explains. Instead, discussions focus on current benefits, potential risks, and how frequently side effects occur — an important distinction when most patient fear is driven by rare outcomes presented without context.
During the COVID-19 pandemic, vaccine discussions often centered on mortality reduction. As risk profiles changed, those benefits evolved. Benefits‑based medicine allows those shifts to be acknowledged openly, rather than clinging to outdated talking points.
“It’s really hard to put that information into context,” Gietzen said. “And I think that’s the kind of information people are missing when they’re hearing opinions instead of evidence.”
Shared Decisions Without Surrendering Expertise
Critically, benefits‑based medicine does not mean abandoning clinical judgment. Gietzen describes the clinician’s role not as a map‑maker handing over directions, but as a guide moving alongside the driver, so to speak — offering the patient perspective, explaining trade‑offs, and helping interpret unfamiliar terrain.
That role becomes especially important when family members are involved, as is often the case with older adults. More voices don’t change the framework; they expand the conversation. The result is a decision‑making process that respects patient autonomy while preserving professional responsibility.
Can This Approach Scale?
The question of scalability may loom large when learning about this model for the first time. Gietzen’s answer is reassuringly pragmatic: Benefits‑based medicine doesn’t require new software, structural overhaul, or months of retraining — it starts with curiosity and a willingness to revisit original evidence.
“The information is there,” he says. “All it requires is individuals being comfortable reviewing clinical trials and asking a few clear questions.”
In his experience, clinicians become confident quickly — often within a handful of studies — because the framework remains consistent regardless of the topic. As with any change, the best place to start is where interest already exists.
A Question Worth Asking
In a healthcare environment driven by metrics, compliance, and expediency, benefits‑based medicine offers a quiet but powerful reframing. It doesn’t reject guidelines or promise certainty. And it definitely doesn’t claim to simplify medicine. Instead, it insists on asking a question that should never feel optional: How well does this work — for this patient, in this moment, given what matters most to them?
For many practices, that question alone may be enough to change the conversation.
