Somewhere along the way, either through poor communication or poor
listening, or just outright bias, the message of shared-decision making
and using the best evidence on behalf of the patient is not being heard.
Suppose all things that are misattributed as movements instead of
methods run this risk. I will say in reviewing a needs assessment
gathered for reviewing the function of the hospital ethics, one
physician commented that "in the era of evidence-based medicine ethics
committees are not needed"
Dan
________________________________
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Joe Matthews
Sent: Thursday, March 22, 2007 5:38 PM
To: [log in to unmask]
Subject: Re: March Academic medicine
Dear Dan et al,
Clearly the problem lies in the popular conception of evidence-based
healthcare as a quantitative discipline. This is not only misleading,
but demonstrably incorrect. The late great programme in EBHC, offered
through the University of Oxford department of continuing education, was
not only appreciative of qualitative research methodologies, it was
directed by a qualitative researcher, Dr. Janet Harris. Students in
this programme received training in quantitative and qualitative
methodologies with an elective module in advanced QRM during the MSc
year. Our struggle against this
misunderstanding-of-what-EBM-is-all-about should point out that diverse
questions require diverse research methodologies to develop best
evidence. Appropriate rigour is required in all of these. Recognizing
high quality research and becoming good consumers and generators of
evidence was the forte of the three year EBHC degree curriculum at
Oxford; alas, sadly, no more.
Best wishes to all,
Joe
-----Original Message-----
From: [log in to unmask]
To: [log in to unmask]
Sent: Thu, 22 Mar 2007 9:16 PM
Subject: March Academic medicine
The following may be of interest
Viewpoint: Moving Beyond Evidence-Based Medicine
[Evidence-Based Medicine]
Henry, Stephen G. MD; Zaner, Richard M. PhD; Dittus, Robert S. MD, MPH
Dr. Henry is an intern, University of Michigan Health System, Department
of Internal Medicine, Ann Arbor, Michigan.
Dr. Zaner is Ann Geddes Stahlman Professor Emeritus of Medical Ethics
and Philosophy of Medicine, Vanderbilt University Medical Center,
Nashville, Tennessee.
Dr. Dittus is Albert and Bernard Werthan Professor of Medicine; chief,
Division of General Internal Medicine and Public Health; director,
Institute for Medicine and Public Health; Vanderbilt University Medical
Center; and director, Geriatric Research, Education and Clinical Center,
VA Tennessee Valley Healthcare System, Nashville, Tennessee.
Correspondence should be addressed to Dr. Henry, Internal Medicine
Residency Program, 3116 G Taubman Center, 1500 East Medical Center
Drive, Ann Arbor, MI 48109-0368; telephone: (734) 545-0989; fax: (734)
936-3654; e-mail: ([log in to unmask]
<javascript:parent.ComposeTo("henrstep%40med.umich.edu", "");> ).
Abstract\l "toc" Picture (Metafile)\l "toc"
The evidence-based medicine movement has remained both well known and
controversial since its inception. The authors reframe the
evidence-based medicine debate by pointing out an underappreciated
epistemological deficiency: evidence-based medicine as currently
conceptualized cannot accommodate concepts that resist quantitative
analysis and therefore cannot logically differentiate human beings from
complex machines. The authors use Michael Polanyi's philosophy of tacit
knowing (which refers to the taken-for-granted knowledge at the
periphery of attention that allows persons to understand the world and
discern meaning in it) as a starting point for rectifying this
deficiency and for working towards an improved, person-centered
epistemology of medical practice. The authors demonstrate that not only
evidence-based medicine but also most traditional theories of medical
practice need a concept such as tacit knowing to account for the kinds
of knowledge human beings actually use. Polanyi's philosophy of tacit
knowing is defined and briefly explained. A medical epistemology that
can account for the tacit dimension of human knowledge and recognize
physicians and patients as persons requires a revised conception of
medical uncertainty and a recognition that clinician-patient
interactions are central to medicine. The authors discuss practical
implications of tacit knowing for medical practice, education, research,
and health care policy and suggest ways for moving beyond evidence-based
medicine towards a comprehensive epistemology of medical practice.
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