Measuring vs. Knowing
Where does evidence-based care take us?
The evidence--which is a huge body of information-- is so inconclusive, it seems that nothing we can do will be supported or denied by the literature to an extent that satisfies our insurance companies.
This is the essence of the health care crisis that we are all in.
Who decides who needs what?
The people who have the power and the money, (ie. The insurance companies and the government) don’t have much trust in the people who have the training and know how (ie. Physicians) to deliver what is needed in terms of care.
How did this happen? We don’t really need some disembodied formula that will be easily read by all telling us what should be done in any given medical care situation. This does seem to be what evidence based care is after, that magic formula that is supposed to arise out of the meta-analysis of decades of diligent RCTs.
The scientific method and the art of medicine have not always seen things eye to eye. There is a complexity in the human body, it’s response and relationship to the human mind, that science has not been able to adequately address.
Medicine has been struggling with establishing standards of care and professionalism in the modern age. People want assurance that their doctor is not a quack. The expectation seems to be perfection and an ability to know everything about the body. Sorry, but that isn’t possible so far.
We just are not spending enough time getting the question right. The disenfranchised clinician doesn’t seem to care or see the need to be invested in this disembodied process of finding out what is supported by the process of science. This is because medicine as a science is stuck in the last century. So then how do we make a decision? We –physicians-and our patients, cannot wait for research to tell us what needs to be done. Instinct and intuition must be cultivated to be an effective clinician. Research supports this idea.
“The notion of imitating whole natural systems stand in stark opposition to reductionist science, which works by breaking such systems down into their component parts in order to understand and then manipulate them…….A healthy sense of all we don’t know –even a sense of mystery—keeps us from reaching for oversimplifications and technological silver bullets”. Micheal Pollan
