"Sontheimer, Daniel MD" <[log in to unmask]> said:
My last post to deal with postmodernism:
Medical Journal of Australia, 2000;172: 332-334
Medicine for the millenium: the challenge of postmodernism
Chan J and Chan J-authors (apologies for the awkward citation)
"EBM teaching emphasises 'knowledge'-- learning the 'facts' and knowing the
'literature'. Sackett et. al. recognised this...'external clinical evidence
can inform but not replace individual clinical expertise and it is this
expertise that decides whether the external evidence applies to the
individual patient at all.'...Producing medical practitioners who know only
clinical pathways and DRGs further widens the gap between the modernist
medical model of dehumanised science (the grand narrative) and the
postmodernist model of unique, lived experience (the small narrative).
Unless the practice of medicine becomes more focused on the unique
individual, with understanding of the limitations of the modern science of
medicine, our role runs the risk of becoming less relevant to people today"
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A typical post-modernist rhetorical tactic is to force a dichotomy of the
form either A or not A, argue that a perfectly complete state of not A is
impossible, then argue that everything is always in state A, then state that
being slightly A is equivalent to being maximally A, and then base a critique
on the fact that everything is maximally A. For example, a typical argument
is no issue is entirely apolitical, therefore everything is political,
therefore politics is the most important part about every issue, therefore,
anyone who says there arguments are not totally based on politics is lying.
The Chan article suggests that EBM is about "producing medical practioners who
know only clinical pathways and DRG's, for example. The argument is
that EBM is only about "dehumanised science" and ignores the "unique
individual." (Going from EBM is about the best available evidence to
EBM is ONLY about evidence, which of course, makes no sense.)
Thus we should abandon EBM, and welcome postmodernism, which
presumably is all about the individual.
Of course, characterizing EBM in this way at best reflects a terrible
oversimplification of the concept. I think EBM was always about making the
best use of clinical evidence to help individual patients. For example, the
short definition at the beginning of Sackett's Evidence Based Medicine (1997)
is "the conscientious, explicit, and judicious use of current best evidence
in making decisions about the care of individual patients."
It might be fun to see how many other forced dichotomies one can find in the
Chan article.
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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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