• Aucun résultat trouvé

The tyranny of evidence-based medicine

N/A
N/A
Protected

Academic year: 2022

Partager "The tyranny of evidence-based medicine"

Copied!
1
0
0

Texte intégral

(1)

Vol 55: october • octobre 2009 Canadian Family PhysicianLe Médecin de famille canadien

979

The tyranny of

evidence-based medicine

Tyranny: rule of a tyrant; despotic exercise of power;

oppression.1

D

r Upshur and Mr Tracy’s article2 in the December 2008 issue of Canadian Family Physician reminds us of the limitations of evidence-based medicine. It is against this backdrop that I am concerned to see more and more physicians who will only practise evidence-based medicine and only make treatment decisions in accordance with guidelines derived from that evidence.

I am concerned because to practise evidence-based medicine only denigrates clinical judgment and experi- ence. It is a simplistic cookbook approach, an excuse for not thinking. It renders all patients with a particular condition the same, to be treated in the same way. It is the antithesis of holistic medicine. It strips away the art of medicine and at the same time cheapens the value of professional practice.

Even those who spend their lives in research or in developing psychometric instruments know that “it is erroneous to discount or forgo the richness of a proper clinical interview and other data-collecting strategies.

These scales are essential for obtaining objective infor- mation, but they are not sufficient to make a diagnosis.

The full appreciation of this perspective is most impor- tant [italics added].”3

We must ask ourselves these questions: Who paid for the study that provided this evidence? Were the results published because they were positive? Would the same study have been published if the results were negative?

Who is promoting the results of the study? Are there other studies, with possibly different results, that we have not considered? Is there other evidence to the con- trary? How do I apply this evidence to individual patient encounters?

It is important that we use “evidence” in evaluation, testing, and treatment decisions. It is equally impor- tant to consider that the person in our examination room is an individual to whom evaluation, testing, and treatment decisions must be tailored to, given the particular setting and needs. Let us be sure to con- sider all aspects of the evidence and all aspects of the individual patient in every clinical encounter.

—Paul Bonisteel MD CCFP FCFP New Harbour, Nfld

references

1. Patterson RF, editor. The university English dictionary, illustrated, and world atlas. London, Engl: Ramboro Books PLC; 1997.

2. Upshur REG, Tracy S. Chronicity and complexity. Is what’s good for the dis- eases always good for the patients? Can Fam Physician 2008;54:1655-8 (Eng), CFPlus (Fr).

3. Triolo SJ, Murphy KR. Attention-deficit scales for adults. Manual for scoring and interpretation. Levittown, PA: Brunner/Mazel Publishers, Inc; 1996. p. 11.

Correspondance Letters

Références

Documents relatifs

Dai computer della Labdoo sono stati rimossi tutti i virus e sono stati riformattati da un network globale di volontari e includono un programma educativo di software gratuito

However, most important is that the care of certain patient populations, like those served by palliative care and emergency medicine, has improved so dramatically in the past

5 There are many aspects of family medicine in which a patient’s illness has progressed beyond the current evidence; or the patient has been discharged by specialty care, yet

Without locking critical reading up and throwing away the key, clinical research data that have been subjected to rigorous analysis or critical synthesis inde- pendent of

Dr Upshur is Professor in the Department of Family and Community Medicine and Dalla Lana School of Public Health at the University of Toronto in Ontario, and Medical Director

Dr Labrecque is Full Professor in the Department of Family Medicine and Emergency Medicine at Laval University and Clinician-Researcher in the Research Centre of the

2 Until a refrigerator-stable vaccine becomes available, however, varicella vac- cine will not be incorporated into the recommend- ed immunization schedule in Canada, as most

(b) The previous question shows that it is enough to consider the case k, l 6 n/2, for otherwise we can replace the representations by isomorphic ones so that these inequalities