Not sure compelled is the right term….coerced is probably more accurate as guidelines get converted to performance measures.

 

“tacit knowledge based on private evidence not accessible to others” What a great “term”.  

 

From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Jeremy Howick
Sent: Tuesday, July 01, 2014 11:02 AM
To: [log in to unmask]
Subject: [EXTERNAL] Re: RealEBM paper

 

Thanks Ben. You are right of course that expert judgment needs to be considered and is explicitly part of EBM. However the term ‘EBM’ has been hijacked and pasted on guidelines even when the guidelines are not based on evidence. Yet because they are guidelines, clinicians feel compelled (sometimes under threat of legal action) to follow them!

 

---

 

 

Well done Neal and colleagues. Nothing to disagree with. However, I found the following sentence a key to the possibility of resolving the dilemmas identified in your paper (“Evidence based medicine: a movement in crisis?”)

 

“Given that real evidence based medicine is as much about when to ignore or over-ride guidelines as how to follow them, those who write guidelines should flag up the need for judgment and informed, shared decision making.”

 

This really bring us back to the seminal 1992 JAMA paper, which introduced EBM and highlighted the role of experts (and nature of expertise); should we trust experts with their tacit knowledge based on private evidence not accessible to others, or should we insist on explicit, public type of knowledge that can be understood by all people who share a common set of the tools (and values)? The public scrutiny and demand for accountability currently heavily favors “rules” over “judgments” …. I am skeptical that we will see fundamental changes any time soon even if successfully enact all initiatives outlined in Box 3 of the paper…

This, of course, is not to say that we should not try, but as they say “it is complicated”J

Best

ben

 

 

From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Neal Maskrey
Sent: Friday, June 13, 2014 2:16 PM
To: [log in to unmask]
Subject: RealEBM paper

 

http://www.bmj.com/content/348/bmj.g3725

 

Trish is up a mountain so I’ll post that this is published online in the BMJ today.

 

The amazing Trish G who led all this magnificently, lots of big brains……….and little me.

 

The BMJ seems to have website problems today; I can only get this via Explorer and not on the iPad (yet?). Be gentle dear friends, be gentle.

 

And of course, thanks as ever for all the stimulation…………

 

Best to all

 

Neal

Professor Neal Maskrey

Consultant Clinical Adviser, Medicines and Prescribing Centre

National Institute for Health and Care Excellence
Level 1A | City Tower | Piccadilly Plaza | Manchester M1 4BT | United Kingdom
Tel: 07770535128

Visiting Professor of Evidence-informed decision making, Keele University, Staffordshire. ST5 5BG

 

The information contained in this message and any attachments is intended for the addressee(s) only. If you are not the addressee, you may not disclose, reproduce or distribute this message. If you have received this message in error, please advise the sender and delete it from your system. Any personal data sent in reply to this message will be used in accordance with provisions of the Data Protection Act 1998 and only for the purposes of the Institute's work.

All messages sent by NICE are checked for viruses, but we recommend that you carry out your own checks on any attachment to this message. We cannot accept liability for any loss or damage caused by software viruses.

http://www.nice.org.uk