A nonevidence‐based lyric essay on evidence‐based medicine, part II: Continuing status quo maintenance education

Abstract

In Part I, I described evidence-based medicine (EBM) as a methodology that potentiates the biomedical epistemology. I used my own story (disabled physician educated at the height of institutional adoption of EBM pedagogy) as substrate upon which EBM worked, starting the timeline at 1975. Part II proceeds on much the same terms, but covers a chronology in which the critique concerning EBM intensifies, yet an entrenched EBM persists. Through the lyric essay technique of juxtaposition and by employing lived experience in the narration, it is my hope that EBM is encountered in the way most of us still encounter it: a data-rich lurch into the sideways.

Humans, machines and decisions: Clinical reasoning in the age of artificial intelligence, evidence‐based medicine and Covid‐19

“…The series of papers that follows [10][11][12][13][14][15][16] adopts a pertinent shift in focus, to bring in the role of the arts and virtue in the development of human reasoning. Papers highlight new prospects for, and challenges to, the education of health professionals, regarding the cultivation of virtue, the role of culture, humility, existential uncertainty and 'hospitality'.…”

“…[10][11][12][13][14] Authors propose ways that practitioners can use their distinctively human skills and capacities to support patients navigating the disorienting territory of acute illness, 14 to provide genuinely person-centred responses to patients whose sense of meaning and identity may be undermined by serious threats to their health, 13 and more broadly to design a curriculum to enable medical learners to develop a fuller understanding of what it means 'to be human, live well, experience loss, encounter disease, and engage in a therapeutic relationship'. 11 The contributors suggest ways to 'broaden understandings of culture and associated workings of power to accommodate the effects of biomedicine's technologising turn', 12 and the section concludes with two rather novel 'non-evidence based lyric essays' 15,16 which chronicle the history of EBM. The essays use this history to reflect upon 'the consequences of medicine's continued quest to be "scientific"', with the goal of demonstrating the need for 'expanding the purview of medical institutions to include not only substantive biomedical capacity, but also scholarly social sciences and humanities infrastructure'.…”

“…The section includes papers on EBM but extends beyond EBM to broader philosophical discussions concerning clinical knowledge, causal reasoning, research and consent-discussing issues of person-centred care and the purpose of medicine, and challenges to clinical judgement presented by the need for virtual care, a need generated by the global pandemic. [17][18][19][20][21][22][23][24][25][26][27] The first three papers in the section [17][18][19] take up the issues that were the topic of the concluding papers in the preceding 'Humanities' section, 15,16 though in this case the author outlines the history of the EBM debate from the perspective of medical philosophy and the history of ideas. The papers provide an extremely helpful account and critical analysis of the debate over the last 30 years, concluding with arguments concerning the possibilities for future development and the relationship between EBM and complexity theory, providerpatient decision making and person-centred care.…”

“…The contributors suggest ways to ‘broaden understandings of culture and associated workings of power to accommodate the effects of biomedicine's technologising turn’, 12 and the section concludes with two rather novel ‘non‐evidence based lyric essays’ 15,16 which chronicle the history of EBM. The essays use this history to reflect upon ‘the consequences of medicine's continued quest to be “scientific”’, with the goal of demonstrating the need for ‘expanding the purview of medical institutions to include not only substantive biomedical capacity, but also scholarly social sciences and humanities infrastructure’ 15 …”

“…The first three papers in the section 17‐19 take up the issues that were the topic of the concluding papers in the preceding ‘Humanities’ section, 15,16 though in this case the author outlines the history of the EBM debate from the perspective of medical philosophy and the history of ideas. The papers provide an extremely helpful account and critical analysis of the debate over the last 30 years, concluding with arguments concerning the possibilities for future development and the relationship between EBM and complexity theory, provider‐patient decision making and person‐centred care.…”