“Evidence of me” in evidence based medicine?

BMJ 2004; 329 doi: http://dx.doi.org/10.1136/bmj.329.7473.1033 (Published 28 October 2004)
Cite this as: BMJ 2004;329:1033

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  1. Susan Lockwood, chair (lockwood@bigpond.com)1
  1. 1 Breast Cancer Action Group, PO Box 281, Fairfield Victoria, Australia, 3130

    Evidence based medicine provides independent, validated advice about treatment options, but does it take sufficient account of individual patients' values to provide them with an optimal health outcome?

    Introduction

    Sackett et al define evidence based medicine as “the integration of best research evidence with clinical expertise and patient values.”1 Although there is extensive literature about the role that patient values do and should play in evidence based medicine, most of this has been written from the perspective of clinical and research communities (see appendix on bmj.com for a discussion of the literature on this topic). Virtually no articles consider the topic from the patients' perspective.

    Clinicians tend to emphasise the rational, scientific, “objective” view of the world. Patients usually do not approach their decision making about their lives on this basis. Although they make decisions based on evidence, they view this evidence through a filter that is based on their own individual values. These values are derived from their lifetime experiences. Thus the values that patients bring to a clinical situation may be very different from the values of their clinicians.2

    This variety of attitudes, approaches to life and decision making, and values makes the use of evidence based medicine at the individual level difficult for patients and for the clinicians working with them.

    Data sources

    This article is based on my 12 years' experience with treatment for breast cancer and eight years' experience as a consumer representative on many different committees, including the development of guidelines for the treatment of advanced breast cancer and ductal carcinoma in situ in Australia. As chair of the Breast Cancer Action Group, I have had many conversations with clinicians and with patients and their families about their experiences of breast cancer. The opinions expressed are my own and not necessarily those of the Breast …

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