Use of Evidence in Acute Stroke Decision-Making: Implications for Evidence-Based Medicine

Abstract

Evidence-Based Medicine proposes a prescriptive model of physician decision-making in which “best evidence” is used to guide best practice. And yet, proponents of EBM acknowledge that EBM fails to offer a systematic theory of physician decision-making. In this paper, we explore how physicians from the neurology and emergency medicine communities have responded to an evolving body of evidence surrounding the acute treatment of patients with ischemic stroke. Through analysis of this case study, we argue that EBM’s vision of evidence-based medical decision-making fails to appreciate a process that we have termed epistemic evaluation. Namely, physicians are required to interpret and apply any knowledge — even what EBM would term “best evidence” — in light of their own knowledge, background and experience. This is consequential for EBM as understanding what physicians do and why they do it would appear to be essential to achieving optimal practice in accordance with best evidence.

Philosophy and the clinic: Stigma, respect and shame

“…Authors raise pertinent and challenging questions concerning our understanding of the nature of health and disease, 23 , 24 diagnosis and the processes of clinical decision making. 25 , 26 These contributions are followed by several highly original articles addressing the relationship between evidence and practice in medicine and healthcare, 27 , 28 , 29 demonstrating the application of specific, philosophically informed approaches to causal reasoning with reference to some very practical contemporary health controversies. 30 , 31 Continuing debates on pressing issues we have emphasized in more recent thematic editions, authors explain and analyse different conceptions of ‘patient‐centred care’ and ‘patient expertise’, 32 , 33 discussing the role of values in shaping our understanding of the mental and medical disorder, 34 , 35 and the relationship between epistemic risk and nonepistemic values in the end of life care.…”