Lately, I have been involved in a couple of debates with critics of EBM.
http://chestjournal.chestpubs.org/content/135/1/245.1.full
http://www.ncbi.nlm.nih.gov/pubmed/20367853
The charge of my opponents was, basically, that EBM consists largely in
the application of rigid rules (particularly about critical appraisal
and hierarchies of evidence).
My understanding, however, is that those are not rules, but heuristics
(rules of thumb) based of reasonable rational assumptions, while EBM
consists in the systematic and judicious integration of expertise and
data from clinical research to solve a patient's problem (which of
course includes preferences and values), not in following rules.
Their rebuttal, is that they are taught and practiced as rules, so that
to be an EBMer is commonly presented as rule-following.
I am confused, as I have always considered EBM more as critical thinking
and rule-breaking.
To consider checklists and hierarchies as prescriptive rules, rather
than working aids, seems to me to be at odds with the foundations of
EBM, since they are largely based on background information. It would
sound like to make a clinical choice based only on data from
pathophysiology.
So, my questions are:
How much is my view shared?
In your experience, how much of EBM curricula are dedicated to
understanding the principles behind the heuristics, rather than teaching
how to follow rules?
thanks,
Piersante Sestini
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