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Roy M. Poses MD
Brown University Center for Primary Care and Prevention
Memorial Hospital of RI
111 Brewster St.
Pawtucket, RI 02860
USA
401 729-2383
fax: 401 729-2494
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Agreed, I think EBM next phase is to grow to a level, where it is used as a
lens/filter with which to guide the practice of Medicine.
Combining the work of EBM with reflective practice (clinical jazz in
Slawson's and Shaughnessy's work), can help move us forward.
The biggest problem with EBM is the attempts to represent "the truth", as
being solelly defined by EBM. Thus, you now have drug reps, and other
soliciters approaching everything with "evidence-based" perspective.
Perhaps there is a more post-modern perpsective for EBM, I think it is in
combining with reflective practice, and then we can avoid this bouncing
around of "the truth"
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It seems to me EBH can supply the best approximation to the truth in certain
circumstances, e.g., the ARR for a particular outcome due to a particular
treatment for a particular kind of patient. Obviously, such approximations
have to be tempered with individual patient characteristics and patients'
values when making a decision. This latter process may still be more art than
science, although the decision sciences may help, again, in certain
circumstances.
I doubt that post-modernism will be helpful. Most post-modernists
take the stance that reality is a social construct (not
that one's interpretation of reality may be influenced by society, which seems
fairly controversial.) But it seems to me, this viewpoint would make not only
EBH, but all of medicine, futile. I actually doubt any post-modernist really
believes this, because true belief in such a viewpoint is not compatible with
living very long. (If the truck or lorry coming toward you is merely a social
construct, will you step out of its way?) Post-modernism, when applied to
other sciences, professions, or scholarly endeavors, has not lead to much
identifiable progress. In fact, it is hard to think of any good it has done.
(But I would be willing to consider any evidence it has done good.) All this
suggests that post-modernism applied to health care will at best be a
distraction, and at worse, a disaster for people, patients, doctors, and other
health care professionals.
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