In teaching EBM/P to medical, dental and physician assistant students I take a simpler approach. I teach them that EBM/P for clinicians at the point of care is simply a means or tool to use to enable them to quickly located evidence that enables them to increase the probability of making a better clinical decision. The point is:
1. At the point of care clinicians do not want to do research but to find answers to a clinical problem or question.
2. The practice of medicine is based upon probability and is an art as well as a science - clinicians will never have perfect information to base clinical decision on.
3. Regardless of the level or quality of evidence/information the clinician has, he or she still must make the clinical decision.
4. The clinicians knowledge, experience and judgement will always be key elements in their decision making.
5. Acceptance and compliance of the clinicians decisions by the patient requires that clinicians build, when possible, a positive relationship with the patient and that they respect the patients belief and desires.
6. Thus EBM is a process aimed at enabling clinicians to better integrate their experience and judgement, the best evidence and the individual patient's physical situation and their values and beliefs to achieve the best possible outcome for the patient.
Therefore I teach the EBM definition presented in the Strauss book and do not see how at point of care the dichotomy between medical humanism and EBM is significant or real.
_
Michael Kronenfeld, Director
Learning Resource Center
A.T. Still U. of the Health Sciences - AZ
5850 E. Still Circle
Mesa, AZ 85206
(480) 219-6091
Http://www.atsu.edu/atsu/lrc
[log in to unmask]
|