Beyond the evidence: the values for the patient

Abstract

Editorial Beyond the evidence: the values for the patient Muito aléM da evidência: os valores para o pacienteThe process of health care always starts at some source of evidence (tacit or explicit) that guides decision-making, and is extinguished at the result (immediate and/or delayed) obtained with the patient.A lot of work, a lot of discussion, much thought, much time has been devoted by many to establish quality measures that can be applied at the different stages of this process, to ensure the highest level of quality in care.There are measures related to evidences (scientific production and citation indexes, graduation strength and critical evaluation); teaching and medical activity (tests for assessing progress, knowledge and performance in undergraduate level, medical residence, graduation courses and accreditation); and the provision of health services (hospital and service accreditation, high-level standardization of care systems, and "big data").Despite these measures, are theoretically connected by the same goal, for various reasons, they are completely dissociated, and have led to a waste of time and resources, competition, difficulty in spreading, and finally, today, being an end in themselves have become larger and more important than their own goal: the patient.Evidence-based medicine, by definition, should take into account the values and preferences of patients. Not to follow this principle, however, has been responsible for the creation of a futile and theoretical world that has conspired against its actual usefulness.Thus, the scientific production is increasing, the teaching of obtaining critical evidence is strong, and guidelines have been increasingly used, but the outcomes that matter to patients, and the practice of shared decision are ignored, making patient-centered medicine utopian.