From EBM to CSM: the evolution of context‐sensitive medicine

Greenhalgh, Trisha; Worrall, J. G.

doi:10.1046/j.1365-2753.1997.00096.x

Cited by 48 publications

(38 citation statements)

References 14 publications

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“…• observational, experimental, extrapolated, experiential 7 • experimental, quasi-experimental, survey, administrative, qualitative, economic, ethical/philosophical, systematic review 32 • legal, epidemiologic 22 • quantitative, qualitative 33 • clinical epidemiology, decision science 24 Defined by general purpose:…”

Section: Defined By Methods Of Collectionmentioning

confidence: 99%

“…23,24 One view -emanating from the roots of "science for guidance" in evidence-based medicine -is that science does indeed reveal universal truths, that is, its role is independent of context. Aspirin works for any individual, sutures hold together anyone's cut, MRI scanners reveal any suspicious mass.…”

Section: Two Views On the Role Of Scientific Evidence -Context-free Vmentioning

confidence: 99%

“…This view is well captured by Greenhalgh: "The scientific tools for dissecting the decision-making process are not those of the clinical epidemiologist but those of the sociologist, the psychologist, the qualitative researcher … It is time that extremists on both sides recognized that there is a science -albeit a social science -to the art of medicine, and that through science (and specifically through decision science) we can systematically explore, validate and refine the art of medicine and integrate it with our diagnostic, therapeutic and epidemiological expertise." 24 Indeed, social science can be put to use to answer not only questions like "will it work in this context?" but also questions about the processes that might yield answers to such questions.…”

Section: Two Views On the Role Of Scientific Evidence -Context-free Vmentioning

confidence: 99%

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Wildlife Health 2.0: Bridging the Knowledge-to-Action Gap

Stephen

2017

Journal of Wildlife Diseases

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OUR PURPOSE VisionOur vision is a strong Canadian healthcare system that is guided by solid, research-based management and policy decisions. MissionTo support evidence-based decision-making in the organization, management, and delivery of health services through funding research, building capacity, and transferring knowledge. StrategyTo establish and foster linkages between decision makers (managers and policy makers) and researchers in the governance of the foundation and in the design and implementation of programs to support research, develop researchers, and transfer knowledge. Main Messages• At a basic level, the notion of evidence concerns facts (actual or asserted) intended for use in support of a conclusion.• Most decision makers view evidence colloquially -"anything that establishes a fact or gives reason for believing something" -and define it by its relevance. Most researchers view evidence scientifically -the use of systematic, replicable methods for production -and define it by its methodology.• Scientists' views on the role of evidence divide into those who emphasize more context-free universal truths (identified closely with "evidence-based medicine") and those who emphasize a context-sensitive role for evidence in a particular decision (identified closely with the applied social sciences).• The appropriate methods for obtaining scientific evidence on context factors are not the same as those for obtaining scientific evidence on program or intervention effectiveness -but this makes such evidence no less "scientific."• Scientific evidence on context can usefully be divided into evidence about attitudes, implementation, organizational capacity, forecasting, economics/finance, and ethics.• Colloquial evidence can usefully be divided into evidence about resources, expert and professional opinion, political judgment, values, habits and traditions, lobbyists and pressure groups, and the particular pragmatics and contingencies of the situation.• These three different forms of evidence -colloquial evidence, scientific evidence on effectiveness, and scientific evidence on context -will not combine of themselves to produce health system guidance; combining and interpreting them requires a deliberative process.• A deliberative process is participative and often follows a period of consultation with relevant stakeholders; it entails both the eliciting and the combining of various types of evidence in order to reach an evidence-based judgment.• There is little evidence on the effectiveness of deliberative processes, though there is much to be said in favour of them on grounds of principle.• The design of a deliberative process is not neutral and may well influence the relative weights assigned to each of the three forms of evidence, thus influencing the extent to which guidance is "evidence-based."• Characteristics of a deliberative process likely to ensure evidence-based guidance include consultation with all parties affected by the outcome, fair representation of scientists and stakeholders, high-quality s...

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Section: Defined By Methods Of Collectionmentioning

confidence: 99%

Section: Two Views On the Role Of Scientific Evidence -Context-free Vmentioning

confidence: 99%

Section: Two Views On the Role Of Scientific Evidence -Context-free Vmentioning

confidence: 99%

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Wildlife Health 2.0: Bridging the Knowledge-to-Action Gap

Stephen

2017

Journal of Wildlife Diseases

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“…', Upshur 79 noted that in response to the emergence of EBM, several commentators had argued for the importance of including qualitative dimensions of clinical practice as constitutive of the base of medical practice, identifying narrative-based medicine 80 , context-sensitive medicine 81 , interpretive grammar 82 , clinical 'jazz' 83 and tacit knowing 84 , in example. Upshur was clear that a common theme among these varying approaches to a more complete form of clinical practice than had been envisioned by EBM was the need to overcome the dualism between facts and values and to foster a realisation and acknowledgement of the complex interplay of values, perceptions and beliefs that frame how medicine is practised, dimensions which have typically and historically escaped the conceptual thinking and methodological preferences of the EBM thesis.…”

Section: In His 2002 Article: 'If Not Evidence Then What?mentioning

confidence: 99%

Science, Humanism, Judgement, Ethics: Person-Centered Medicine as an Emergent Model of Modern Clinical Practice / Наука, Гуманизм, Преценка, Этика, Пациент. Гуманизм В Медицина - Новая Модель В Современн Ой Клинической Практике

Miles¹

2013

Folia Medica

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The Medical University of Plovdiv (MUP) has as its motto 'Committed to humanity". But what does humanity in modern medicine mean? Is it possible to practise a form of medicine that is without humanity? In the current article, it is argued that modern medicine is increasingly being practised in a de-personalised fashion, where the patient is understood not as a unique human individual, a person, but rather as a subject or an object and more in the manner of a complex biological machine. Medicine has, it is contended, become distracted from its duty to care, comfort and console as well as to ameliorate, attenuate and cure and that the rapid development of medicine's scientific knowledge is, paradoxically, principally causative. Signal occurrences in the 'patient as a person' movement are reviewed, together with the emergence of the evidence-based medicine (EBM) and patientcentered care (PCC) movements. The characteristics of a model of medicine evolving in response to medicine's current deficiencies -person-centered healthcare (PCH) -are noted and described. In seeking to apply science with humanism, via clinical judgement, within an ethical framework, it is contended that PCH will prove to be far more responsive to the needs of the individual patient and his/her personal circumstances than current models of practice, so that neither a reductive anatomico-pathological, disease-centric model of illness (EBM), nor an aggressive patient-directed, consumerist form of care (PCC) is allowed continued dominance within modern healthcare systems. In conclusion, it is argued that PCH will enable affordable advances in biomedicine and technology to be delivered to patients within a humanistic framework of clinical practice that recognises the patient as a person and which takes full account of his/her stories, values, preferences, goals, aspirations, fears, worries, hopes, cultural context and which responds to his/her psychological, emotional, spiritual and social necessities in addition to his/her physical needs. MUP, in assimilating such arguments and introducing person-centered medicine teaching into the University, is engaged in a notable and laudable initiative which will function as a salutary example to other medical schools within Europe and elsewhere.

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“…clinicians acquire through clinical experience and clinical practice' (7). And so, evidence-based medicine does include clinical experience.…”

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confidence: 99%