There’s no arguing the fact that evidence-based medicine (EBM) is moving us in the right direction as far as treating and preventing illness in medicine as a whole, but what does EBM, in its current interpretation, mean for medicine as an individualized art?
Everything new or controversial in medicine seems to have a swinging pendulum. From vaccines to hormonal treatment to alternative therapies, the pendulums of medicine seem to be in constant flux. In recent years it seems the pendulum of EBM has begun to creep towards an extreme of blind compliance to broad directions, rather than a thoughtful consideration of the evidence in light of a patient’s individual circumstances.
Let me preface my thoughts by saying that I truly believe basing the core of our actions on research and regimen is of the utmost importance; it ensures that care is standardized and backed by reproducible outcomes. However, from day one of medical school, we stand in a cold anatomy lab and listen to a professor tell us that cadaver dissections are sacred and invaluable, because they teach us that everyone is unique. We don’t really understand the truth in that, though, until we make our first incision and see first-hand that it’s not just what’s on the outside that makes each of us an individual.
So, when a patient comes in who seems to lie in a gray zone, one who meets the criteria for following a typical protocol or EBM algorithm, but makes you question in the back of your head if that’s truly the best thing for this individual patient, do we blindly follow it? I would argue that evidence-based medicine should allow wiggle room to take individuals into consideration. Life itself is rarely black and white, trying to force medicine to be seems a silly, and likely impossible, feat.
Are the protocols published by our most trusted doctors and reviewed by our peers meant to be blindly followed or do they leave room for individual care and interpretation? I’d argue that they beg for individualization.
By adopting a blind culture of protocols and guidelines, albeit with the best of intentions, have we sacrificed our ability to practice the art of medicine? How do we find balance between excellent, standardized care and individualized, artful medicine?
After all, we did take an oath: “To preserve the purity of [our] life and [our] arts.”
Danielle Jones is an obstetrics-gynecology resident. This article originally appeared in The American Resident Project.
