Thoughts on ways to improve the management of professional services firms

Monday, November 24, 2008

A Scottish doctor's reservations about evidence based medicine - measurable vs the immeasurable

In my on-going series on the development of a discipline of practice, see Establishing a Discipline of Practice - stocktake of posts, I discussed the concept and some of the implications of evidence based medicine.

In Real world medicine a Scottish doctor expresses his concerns about the application of evidence based medicine in a UK context. In doing so, he makes a distinction between the measurable and immeasurable, suggesting that blind focus on the measurable

He has a point. Part of the reason for the development of evidence based medicine lay in the need to challenge and test previously accepted medical nostrums. However its blind formalised application can distort practice to just the measurable. This holds especially where application is mandated through formalised Government rules.

The issue of measurable vs immeasurable links to craft vs science.

Any practitioner knows that certain things work from experience even though the results cannot be proved in a rigorous scientific fashion. This is the craft component.

Yet we also know that practitioners, and this is not limited to medicine, apply things from belief independent of real results. Belief stands as a barrier. Evidence based medicine aims to test this. This is the scientific component.

In thinking about the development of a discipline of practice, we need to take explicit account of the importance of the immeasurable. Measurement is not all.


A comment from Bob Quiggin on another post really made me laugh:

Just on evidence based Scottish doctors, perhaps the most famous is Sir Arthur Conan Doyle, who used to emphasise the importance of observation and evidence in medicine as a medical lecturer.

One of his favoured tricks was to take a beaker of foul tasting fluid, dip his finger into it, taste it, pull a face and then ask the class to do the same. Only after they had all tasted the fluid did he take them to task for not noticing that he had dipped one finger, but tasted another. Unlike them. :)

Nice story, isn't it!


DrBob said...

Like the anecdote! I trained at Edinburgh Uni and was taught that finger dipping trick there! Looks like Conan Doyle's influence in Edinburgh continues.....
I think you're absolutely right with this observation. Belief often trumps the evidence!
From a scientific perspective what this issue highlights is the need to develop the tools to critically assess the immeasurable - and, you know, that really is a BIG challenge!

Jim Belshaw said...

Thank, Dr Bob, for taking the time. I was actually CEO of specialist medical college for two years, so I have some understanding of the doctor position. I do want to see more cross-fertilisation between the professions. And the need to see a way to take into account the immeasurable has never been mor important.

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