Roy Poses arguments though valid presents a philosophical approach to medicine. Newtonian physics was considered invinsible till Quantam physics came around. Though one cannot exclude the work of Newton, one has to admit that there are other ways in which the laws of the world works. As one expert in complexity science mentioned, " I still depend on Newtonian principles to land me down safely in the airport!".
The quest for thruth is always there and that is the realm of all physicians. Why would someone try to practice medicine any other way ( once could ponder over this too). To go to a point "B" from a point" A" we have to make a start and EBM is one of those tools which is making an effort and so are others who are using other techniques ( the non EBM, best evidence approach).
The trademark of EBM seems to the point of contention and not the ability of a physician or health personal ( EBHC may be the right word) to deliver the best care . The equation for the best care might be ; Best care =EBM+ compassion+ empathy+ hidden curriculum+ whole variety of qualitative stuff.
Amit Ghosh
> ----------
> From: Roy Poses[SMTP:[log in to unmask]]
> Reply To: Roy Poses
> Sent: Wednesday, September 17, 2003 9:00 AM
> To: [log in to unmask]
> Subject: Re: evidence for evidence based practice
>
> At 01:13 PM 9/17/03 +0100, Piersante Sestini wrote:
> >Roy Poses wrote:
> >>
> >> professes extreme relativism. This notion that there is no truth out there
> >> is profoundly anti-scientific. (Plus, would you believe anyone who starts
> >> out by saying there is no such thing as truth?)
> >
> >I apologize for jumping in after having been away from the list for
> >several months, but I would like to make the point that we are searching
> >for the best available evidence, not for the truth. Indeed, the whole
> >process of EBM/HC is to me the best way to deal with a world of
> >uncertainity, where the choice supported by the best evidence today
> >might be different tomorrow. Or maybe even today, for a patient with
> >different preferences and expectations.
> >
> >So it is not disturbing to me if somebody does or does not believe that
> >the truth exists, as far as he/she acknowledges that criteria for
> >identifying the best available evidence "around the care of our patient"
> >(to use postmodern jargon :-) do exist, within the specific framework of
> >the preferences and values of our patient.
>
> But how would you judge what evidence is the "best available?" Why try to
> find the best available evidence unless best available means most likely to
> reflect the truth?
>
> ...............................................................
> Roy M. Poses MD
> Director of Research, General Internal Medicine
> Brown University Center for Primary Care and Prevention
> Memorial Hospital of Rhode Island
> 111 Brewster St.
> Pawtucket
> RI 02860
> USA
> 401 729-3400
> fax 401 729-2494
> [log in to unmask]
>
|