7 Alternatives to Evidence-based medicine

[Paul Edwards]

As you are aware, Jim is a great believer in evidence-based medicine.

 

Evidence-based medicine is the use of current best evidence to make decisions about the care and treatment of individual patients.

 

What are the alternatives to evidence-based medicine?

 

Some Australian doctors wrote a humorous article in the British Medical Journal suggesting that there were 7 Alternatives to Evidence-based medicine.

 

These alternatives are:

 

Eminence based medicine  

The more senior the doctor, the less importance he or she places on the need for anything as mundane as evidence.   Experience, it seems, is worth any amount of evidence. These doctors have a touching faith in clinical experience, which has been defined as “making the same mistakes with increasing confidence over an impressive number of years.”

 

Vehemence based medicine

Instead of evidence, the loudest doctor decides what should be done.

 

Eloquence based medicine

The year round suntan, carnation in the button hole, silk tie, Armani suit, and tongue should all be equally smooth.  Smooth talking substitutes for evidence.

 

Providence based medicine

If the caring doctor has no idea of what to do next, the decision may be best left in the hands of the Almighty.   Too many specialists, unfortunately, are unable to resist giving God a hand with the decision making.

 

Diffidence based medicine

The timid doctor may hesitate and do nothing.  This, of course, may be better than doing something merely because it hurts the doctor's pride to do nothing.

 

Nervousness based medicine

Fear of litigation is a powerful stimulus to overinvestigation and overtreatment.

 

Confidence based medicine

This is restricted to surgeons in the operating theatre.

 

Recently it has been suggested that there is also an 8^th alternative:

 

Profit-based medicine (also known as opulence based medicine)

This is the conscientious, explicit and judicious use of the most profitable and lucrative interventions when making decisions about the care of individual patients.