JISCMail - EVIDENCE-BASED-HEALTH Archives

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

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]).

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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.