Stef (firecat) wrote,

Paradigms of practicing medicine

This essay basically says (my own words) "In our enthusiasm for evidence-based medicine (which uses statistics and large population samples to evaluate treatments and create clinical guidelines), let's make sure not to throw out things doctors learn through many years of practice seeing one patient at a time." It says it really, really well.

"Why do we always end up here? Evidence-based medicine’s conceptual cul-de-sacs and some off-road alternative routes" by Trisha Greenhalgh, M.D. (Journal of Primary Health Care 2012; 4(2))

Researchers in dominant paradigms tend to be very keen on procedure. They set up committees to define and police the rules of their paradigm, awarding grants and accolades to those who follow those rules. This entirely circular exercise works very well just after the establishment of a new paradigm, since building systematically on what has gone before is an efficient and effective route to scientific progress. But once new discoveries have stretched the paradigm to its limits, these same rules and procedures become counterproductive and constraining. That’s what I mean by conceptual cul-de-sacs.
the skilled practice of medicine is not merely about knowing the rules, but about deciding which rule is most relevant. This remains under-acknowledged and undertheorised in the dominant EBM paradigm. Illness may be a narrative, but just as in law, just as in literature, there is no text that is self-interpreting.
I think something sinister is happening, mainly because of the striking circumstantial resonance between the reductionism of EBM and the reductionism of contemporary policymaking.
EBM isn’t inherently wrong, but it plays to a vision of science that is characterised by predictive certainty—a vision that is taught to schoolchildren and perpetuated in the media, a vision of simple logic with readily deduced details and rule-governed consequences. It is this logic, coupled with the values of consumerism, which appear to have prompted the coalition government to develop a one-dimensional metric of human happiness which will light up like a thermometer bulb when policy tickles the public G-spot.
These books that she mentions sound very interesting:
How Doctors Think by Kathryn Montgomery (not the book of the same name by Jerome Groopman)
Complex Knowledge by Professor Hari Tsoukas
Upheavals of Thought: The Intelligence of Emotions by Martha Nussbaum
The Logic of Care by Annemarie Mol

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Tags: health, linkage, science
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