Science and proven experience : a Swedish variety of evidence based medicine and a way to better risk analysis?

• A key question for evidence-based medicine (EBM) is how best to model the way in which EBM should‘[integrate] individual clinical expertise and the best external evidence’. We argue that the formulations and models available in the literature today are modest variations on a common theme and face very similar problems when it comes to risk analysis, which is here understood as a decision procedure comprising a factual assessment of risk, the risk assessment, and the decision what to do based on this assessment, the risk management. Both the early and updated models of evidence-based clinical decisions presented in the writings of Haynes, Devereaux and Guyatt assume that EBM consists of, among other things, evidence from clinical research together with information about patients’ values and clinical expertise. On this A-view, EBM describes all that goes on in a specific justifiable medical decision. There is, however, an alternative interpretation of EBM, the B-view, in which EBM describes just one component of the decision situation (a component usually based on evidence from clinical research) and in which, together with other types of evidence, EBM leads to a justifiable clincial decision but does not describe the decision itself. This B-view is inspired by a 100-years older version of EBM, a Swedish standard requiring medical decision-making, professional risk-taking and practice to be in accordance with‘science and proven experience’(VBE). In the paper, we outline how the Swedish concept leads to an improved understanding of the way in which scientific evidence and clinical experience can and cannot be integrated in light of EBM. How scientific evidence and clinical experience is integrated influences both the way we do risk assessment and risk management. In addition, the paper sketches the as yet unexplored historical background to VBE and EBM.

• A key question for evidence-based medicine (EBM) is how best to model theway in which EBM should ‘[integrate] individual clinical expertise and the bestexternal evidence’. We argue that the formulations and models available inthe literature today are modest variations on a common theme and face verysimilar problems when it comes to risk analysis, which is here understoodas a decision procedure comprising a factual assessment of risk, the riskassessment, and the decision what to do based on this assessment, the riskmanagement. Both the early and updated models of evidence-based clinicaldecisions presented in the writings of Haynes, Devereaux and Guyatt assumethat EBM consists of, among other things, evidence from clinical researchtogether with information about patients’ values and clinical expertise. Onthis A-view, EBM describes all that goes on in a specific justifiable medicaldecision. There is, however, an alternative interpretation of EBM, the B-view,in which EBM describes just one component of the decision situation (acomponent usually based on evidence from clinical research) and in which,together with other types of evidence, EBM leads to a justifiable clincialdecision but does not describe the decision itself. This B-view is inspiredby a 100-years older version of EBM, a Swedish standard requiring medicaldecision-making, professional risk-taking and practice to be in accordancewith ‘science and proven experience’ (VBE). In the paper, we outline how theSwedish concept leads to an improved understanding of the way in whichscientific evidence and clinical experience can and cannot be integrated inlight of EBM. How scientific evidence and clinical experience is integratedinfluences both the way we do risk assessment and risk management. Inaddition, the paper sketches the as yet unexplored historical backgroundto VBE and EBM.

Ämnesord

HUMANIORA  -- Filosofi, etik och religion -- Filosofi (hsv//swe)

HUMANITIES  -- Philosophy, Ethics and Religion -- Philosophy (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Medicinsk etik (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Medical Ethics (hsv//eng)

Nyckelord

evidence based medicine

Philosophy of science

vetenskap och beprövad erfarenhet

Science and proven experience

science and proven experience

evidence-based medicine

risk analysis

risk management

philosophy of risk

Publikations- och innehållstyp

art (ämneskategori)

ref (ämneskategori)