How does evidence-based medicine affect the art of medicine?

There’s no arguing the fact that evidence-based medicine (EBM) is moving us in the right direction as far as treating and preventing illness in medicine as a whole, but what does EBM, in its current interpretation, mean for medicine as an individualized art?

Everything new or controversial in medicine seems to have a swinging pendulum. From vaccines to hormonal treatment to alternative therapies, the pendulums of medicine seem to be in constant flux. In recent years it seems the pendulum of EBM has begun to creep towards an extreme of blind compliance to broad directions, rather than a thoughtful consideration of the evidence in light of a patient’s individual circumstances.

Let me preface my thoughts by saying that I truly believe basing the core of our actions on research and regimen is of the utmost importance; it ensures that care is standardized and backed by reproducible outcomes. However, from day one of medical school, we stand in a cold anatomy lab and listen to a professor tell us that cadaver dissections are sacred and invaluable, because they teach us that everyone is unique. We don’t really understand the truth in that, though, until we make our first incision and see first-hand that it’s not just what’s on the outside that makes each of us an individual.

So, when a patient comes in who seems to lie in a gray zone, one who meets the criteria for following a typical protocol or EBM algorithm, but makes you question in the back of your head if that’s truly the best thing for this individual patient, do we blindly follow it? I would argue that evidence-based medicine should allow wiggle room to take individuals into consideration. Life itself is rarely black and white, trying to force medicine to be seems a silly, and likely impossible, feat.

Are the protocols published by our most trusted doctors and reviewed by our peers meant to be blindly followed or do they leave room for individual care and interpretation? I’d argue that they beg for individualization.

By adopting a blind culture of protocols and guidelines, albeit with the best of intentions, have we sacrificed our ability to practice the art of medicine? How do we find balance between excellent, standardized care and individualized, artful medicine?

After all, we did take an oath: “To preserve the purity of [our] life and [our] arts.”

Danielle Jones is an obstetrics-gynecology resident. This article originally appeared in The American Resident Project.

Comments are moderated before they are published. Please read the comment policy.

  • simidbg

    We can offer to individualise, only if we can ensure better than the EB standard of care.

    • PoliticallyIncorrectMD

      Are you aware of any evidence that so called “evidence-based-medicine” provides better outcomes? Do share!

  • PoliticallyIncorrectMD

    Answering my own question below: there is no evidence that so called “evidence based medicine” provides better outcomes. Its only “benefits” so far are not in the realm of patients care. It creates an impression that anybody with minimal training can practice medicine as long as they follow approved “guidelines”. It allows physicians not to make decisions. It allows bureaucrats to practice medicine and decide if certain medical interventions are appropriate. Like any epidemiological approach, it averages outcomes and completely ignores individual patients. It defies scientific method by rejecting the need for understanding the underlying pathology. Should I continue?

  • Dorothygreen

    Pretty much what I was going to say too. And then there is Time magazine’s June 23, 2014 EAT BUTTER article we were wrong” about Ancel Keys’ and saturated fat.

    Much of the “EBM” is used for chronic (preventable) diseases – heart disease, diabetes etc. So, how many physicians are going to buck the USDA, AHA and probably the AMA and tell their patients the truth about statins and what a healthy diet really is. Dr. Wahls just bypassed all what has been done to date. She did some extraordinary research on how mitochondria function and what nutrients the brain requires. From this she developed an optimal nutrition diet that has reversed her secondary progressive multiple sclerosis. Don’t see how a better way to eat is possible. This is my evidence.

  • PoliticallyIncorrectMD

    As I mentioned, too many physicians hide behind “evidence based” guidelines to avoid thinking and making decisions. Why would they denounce something making their professional life comfortable and thoughtless.

Most Popular