Intended for healthcare professionals

Analysis

Making evidence based medicine work for individual patients

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2452 (Published 16 May 2016) Cite this as: BMJ 2016;353:i2452

The Evidence and the Decision are two quite distinct things

As Professor Haslam points out in his response:

'Guidelines have their place in providing a population-level steer on the most clinically and cost effective ways to treat different diseases and conditions. Patient care should not be about prescriptive, top-down medicine. '

The evidence is the best source on which to base descriptions of clinical outcomes, but it has been made very clear recently by some British court rulings that the role of doctors is to describe clinical outcomes with and without any offered treatments, and the decision-making about whether to accept or refuse any of those offered treatments then falls to the patient. Patients are allowed to incorporate personal and non-clinical factors, into their decision-making: so 'EBM' can never prescribe the decision-making of any particular patient, but it can of course steer service provision [where we are considering 'averages'].

And the above is clearly a description of a demarcation of roles: doctors and patients are making different decisions (doctors decide what to offer, but only patients decide what to accept) and I personally find it very unhelpful to describe that as 'shared decision-making'.

Competing interests: No competing interests

21 May 2016
Michael H Stone
Retired Non Clinical
None Private Individual
Covwntry CV2 4HN