We need ideas based medicine

Des Spence repeats the common misconception about Evidence-based
Medicine, and thus suggests that we should "throw the baby out with the
bathwater".

EBM is not the raw material (the body of evidence), but an approach
and a set of tools for appraising and applying evidence. Yes, the extant
evidence is commercially biased, often reductionist and not always easy to
generalise to our primary care populations. However, EBM skills should
assist to highlight these deficiencies more than the previous paradigm of
unquestionably accepting the received wisdom from higher up the authority
heirarchy. In fact he uses some of these skills in his critique of recent
slavish worship to certain types of evidence and performance criteria. So
he is being more evidence based than those who don't understand the limits
to their evidence base.

Ideas generated from real GP cases could be an ideal way to stimulate
new and valid research relevant to primary care. If a pattern seems to
emerge, then higher levels of study design could look for support of a
causal relationship. Qualitative and narrative evidence has a large role
in general practice, to generate initial evidence, and as the guidance for
funnelling 'reductionist' evidence back to the broader primary care
setting and individual patients.

Experience, good clinical skills including careful listening, good
supporting evidence and judicious application of that evidence are the
like the legs of a chair. They are complementary, not opposites.

Competing interests:
I teach EBM to medical students