The problems with EBM
Evidence-based medicine (EBM) is a philosophy of the practice of medicine which may seem like motherhood and apple pie, obviously true and pointless in arguing against. However, many medical practitioners have issues with EBM. Proponents of EBM might argue that none of these criticisms are valid reasons not to practice EBM in its purest form, but certainly EBM as it is practised has several issues.
Trisha Greenhalgh wrote in the BMJ recently of a "movement in crisis". The reasons for such a crisis include:
• The evidence based “quality mark” has been misappropriated by vested interests
• The volume of evidence, especially clinical guidelines, has become unmanageable
• Statistically significant benefits may be marginal in clinical practice
• Inflexible rules and technology driven prompts may produce care that is management driven rather than patient centred
• Evidence based guidelines often map poorly to complex multimorbidity
Source: http://www.bmj.com/content/348/bmj.g3725
Much evidence is not a good fit for the individual patient with a complex set of interacting problems. EBM potentially reduces the importance of patient preference and shared decision-making. There is also a tendency to excessive confidence in prospective randomised controlled trials, despite all the problems and limitations of the scientific method. There is always an element of interpretation of scientific results and social construction of theories, but this aspect of the sociology of scientific knowledge is apparently neglected.
The "groupies" of evidence-based medicine (not doctors generally, but so-called "skeptics") feel empowered to bully providers and, worse of all, patients who opt for medicine that is not evidence-based. There is an element akin to religious fundamentalism, although most of that movement is avowedly humanist. The reasons for this connection are not clear, but there seems to be a parallel with the trolling of the religious by the followers of Dawkins.
• The volume of evidence, especially clinical guidelines, has become unmanageable
• Statistically significant benefits may be marginal in clinical practice
• Inflexible rules and technology driven prompts may produce care that is management driven rather than patient centred
• Evidence based guidelines often map poorly to complex multimorbidity
Source: http://www.bmj.com/content/348/bmj.g3725
Much evidence is not a good fit for the individual patient with a complex set of interacting problems. EBM potentially reduces the importance of patient preference and shared decision-making. There is also a tendency to excessive confidence in prospective randomised controlled trials, despite all the problems and limitations of the scientific method. There is always an element of interpretation of scientific results and social construction of theories, but this aspect of the sociology of scientific knowledge is apparently neglected.
The "groupies" of evidence-based medicine (not doctors generally, but so-called "skeptics") feel empowered to bully providers and, worse of all, patients who opt for medicine that is not evidence-based. There is an element akin to religious fundamentalism, although most of that movement is avowedly humanist. The reasons for this connection are not clear, but there seems to be a parallel with the trolling of the religious by the followers of Dawkins.
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