Evidence does not make decisions, people "in contexts" do.
Haynes, Devereaux, and Guyatt, argue against evidence based medicine
(EBM) because of “evidence does not make decisions, people do”, and
decisions vary from one patient to another according to individual
clinical circumstances and their preferences. So, a new term is proposed -
research enhanced health care- to facilitate better use of evidence in
clinical practice, especially if the wishes of the patient are taken into
account. We want to suggest a shade (especially en general medicine): to
make decisions (with people) “in contexts” (1).
What is our evidence into our practice and which is constructed? EBM
is only one possibility which must be chosen after appraising context,
and that must be put in context after their application (2), and there
are a lot of general medicine characteristic ways to facilitate make
decisions in real life (3, 4). What are these ways used to make
“good/proper” clinical decisions in general medicine?: 1.- Internal
congruence with doctor (emotion, intuition, ethics, knowledge, reasoning,
experience, empathy, empowerment, compassion, creativity, the five
senses...); 2.- Congruence with other actors (to put in context, strategic
planification, patiens and communities participation, effectiveness,
multiple relationships within a ecologycal system...); 3.- Internal
congruence with clinical semiology (EBM, clinical epidemiology, congruence
of pieces of information from diverse sources...); 4.- Time congruence
(continuity of personal medical care, time proof, narrative based
medicine...). So, to make decisions -with people- we must begin with the
context and only after this to go with the symptoms and signs.
REFERENCES:
1.- Turabián JL, Pérez Franco B. Actividades Comunitarias en medicina de
familia y atención primaria. Madrid: Díaz de Santos, 2001
2.-Rogers CR. On becoming a person. Boston: Houghton Mifflin Company; 1961
3.-Turabián-Fernández JL, Pérez-Franco B. El futuro de la medicina de
familia. Aten Primaria 2001; 28: 657 – 661
4.-Malterud K. The art and science of clinical knowledge: evidence beyond
measures and numbers. Lancet 2001; 358: 397-400
Rapid Response:
Evidence does not make decisions, people "in contexts" do.
Haynes, Devereaux, and Guyatt, argue against evidence based medicine
(EBM) because of “evidence does not make decisions, people do”, and
decisions vary from one patient to another according to individual
clinical circumstances and their preferences. So, a new term is proposed -
research enhanced health care- to facilitate better use of evidence in
clinical practice, especially if the wishes of the patient are taken into
account. We want to suggest a shade (especially en general medicine): to
make decisions (with people) “in contexts” (1).
What is our evidence into our practice and which is constructed? EBM
is only one possibility which must be chosen after appraising context,
and that must be put in context after their application (2), and there
are a lot of general medicine characteristic ways to facilitate make
decisions in real life (3, 4). What are these ways used to make
“good/proper” clinical decisions in general medicine?: 1.- Internal
congruence with doctor (emotion, intuition, ethics, knowledge, reasoning,
experience, empathy, empowerment, compassion, creativity, the five
senses...); 2.- Congruence with other actors (to put in context, strategic
planification, patiens and communities participation, effectiveness,
multiple relationships within a ecologycal system...); 3.- Internal
congruence with clinical semiology (EBM, clinical epidemiology, congruence
of pieces of information from diverse sources...); 4.- Time congruence
(continuity of personal medical care, time proof, narrative based
medicine...). So, to make decisions -with people- we must begin with the
context and only after this to go with the symptoms and signs.
REFERENCES:
1.- Turabián JL, Pérez Franco B. Actividades Comunitarias en medicina de
familia y atención primaria. Madrid: Díaz de Santos, 2001
2.-Rogers CR. On becoming a person. Boston: Houghton Mifflin Company; 1961
3.-Turabián-Fernández JL, Pérez-Franco B. El futuro de la medicina de
familia. Aten Primaria 2001; 28: 657 – 661
4.-Malterud K. The art and science of clinical knowledge: evidence beyond
measures and numbers. Lancet 2001; 358: 397-400
Competing interests: No competing interests