Tuesday, April 19, 2005

Evidence-based Medicine or Medicine-based Evidence?


The term “evidence-based medicine” has been much bandied about for the last decade or so. It has been used globally as the “in” way of practicing medicine.

As far as the scientific process is concerned, EBM seems to make the most sense in terms of giving the patients the best available treatment to treat their respective medical problems. In layperson’s language, we doctors are using proven methods of treatment.

However, Medicine is not purely a science – many would agree with me that it is also an art. One hopes that with the use of EBM, physicians will not lose that extra touch of compassion that should come with healing the sick. Patients are not just subjects of scientific studies. They are human beings first, who happen to be sick.

Speaking from experience as a physician, a patient and now a pencil pusher, I notice that the art of communication between doctor and patient has been lost. I hear of many complaints arising from either a lack of communication, miscommunication, or insensitivity in communication between the doctor and his/her patients. Have we become so evidence-based that we now lack the human touch when it comes to dealing with our fellow Man? Is the process of keeping the patient and his family involved in managing their own health so difficult, or has it just become a low priority in the busy doctors’ schedules?

Perhaps the “touchy-feely” aspects of medicine is not emphasized enough in medical school. Communication, compassion, and empathy are all important parts of the doctor-patient relationship. Oftentimes, harried doctors, jaded by their experience with upset patients & family members neglect to develop these “softer” skills of being a healer. Hard as it may be, it is time to take a step back and consider practicing “medicine-based evidence” (to coin a phrase that I recently picked up while attending a very enlightening seminar) in concurrence with evidence-based medicine.

Instead of referring to a patient as a bed number (“Bed 12 needs a urine culture done.”) or a diagnosis (“The Ca Liver needs a LFT done today”), we should refer to them by their names and remember that they are first and foremost, someone’s mother/father/daughter/son. We should also remember that doctors are first and foremost, human beings. Somewhere along the way to attaining a medical degree and becoming a doctor, perhaps because we have focused so much on the evidence-based Science of Medicine, many of us have forgotten or lost the Art of the Practice of Medicine.

I hope that the Faculty members in NUS will consider including an extra module in the medical curriculum to “teach” and show budding doctors the importance of the softer and more human side of Medicine.

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