The Art of Medicine: When Evidence Based Medicine Is Not Enough

BLOG-EVIDENCE-BASED-GAVELModern living presents us with an overwhelming amount of options when it comes to every aspect of our lives. Healthcare is no exception. With research studies and treatment guidelines being created on a daily basis, they can often leave us feeling confused about which option is best for us when we are faced with an ailment. It is of the utmost importance that we question and research our options when considering the practitioners and treatments that are most fitting for our needs and lifestyles.

In recent years, an incredible shift has occurred in the healthcare industry. While standardized medicine is still very prominent, an increasing number of people are turning to more preventative or alternative medicine to achieve an optimal state of wellbeing. Holistic therapies such as acupuncture, reiki and energy healing have paved the way for a wider vision of wellness allowing practices such as integrative medicine to be born as it merges the world of biomedicine with alternative medicine. As with any shift in mindset this has created two opposing schools of thought, those who advocate for evidence based medicine and those who do not.

Evidence based medicine, originally created to optimize medical decision-making has become a hot topic of discussion within the healthcare profession leaving many practitioners knee deep in a battle between renaissance versus reformation. While the term and the concept became quite popular in the late 1980s, it hasn’t been until recently that EBM has really been put to the test with a growing number of advocates and an equally growing number of opponents.

So what is evidence based medicine (EBM)?

Essentially evidence-based medicine is an approach to healthcare that emphasizes evidence collected during conducted research and randomized controlled trials in order to create treatment guidelines and policies meant to improve decisions about individual patients.

Sounds harmless enough, doesn’t it? In theory it is. The five step process associated with EBM professionals is meant to establish safer, consistent and more cost effective care through questioning, testing, and evaluating clinical trials. While knowledge is important to all aspects of wellbeing, the issue arises when practitioners see this process as the be all and end all to practicing healthcare. The top priority is suddenly placed on data, numbers and guidelines and not on to the actual individual.

What’s that mean for you?

As someone seeking a healthcare or wellness professional you should always do your research on what each practitioner and treatment can contribute to your needs and concerns. It’s important to be acquainted with what standardized medicine can offer as well as what types of holistic therapies and alternative medicine can supplement or bring a whole hearted approach to your needs. While each play an important role, many EBM practitioners are very quick to dismiss the benefits of alternative or holistic approaches simply because their benefits cannot be scientifically measured. It is crucial that you ask yourself, does measuring the results outweigh experiencing the benefits?

<H3>Here are a few things to keep in mind when finding the right treatments and therapies for you:</H3>

ISA-HERRERA-CRISIS-IN-EVIDENCE-BASEDIndividual Care versus Population-Data. Access to endless data and research is a great first step when managing or treating any condition. With that said, EBM professionals rely heavily on population-based numbers that can often homogenize an arena that is incredibly heterogeneous. While trials might show success rates for a large number of patients, these trials cannot possibly encompass the complexities involved with each individual case. The research does not account for multi-morbidity which has grown increasingly common as more patients are experiencing several concurrent chronic conditions at once. This brings into question how much ground the evidence- based research can truly cover in a world filled with so many unique and complex circumstances.

Expertise versus Standardized Guidelines. The basis of the EBM movement revolves around guidelines created in order to unify the healthcare industry. While establishing a standard of care is an important addition to the profession, by creating strict step-by-step protocols practitioners are stripped of allowing their wisdom and expertise to grow and flourish. In theory this may reduce the risk of receiving subpar treatment, but it also reduces the chances of arriving at an innovative treatment plan. The guidelines are growing in such an overwhelming manner that many professionals cannot read, much less implement all of the information being output on a yearly basis. Yes, there are certain guidelines that one must follow but at which point does those years of knowledge, experience and pure intuition come into play?

Relationship Based Care versus Checklists. As with any type of standardization, the goal is to make sure that everything has the same features and level of quality which ultimately calls for lists, checklists, and grading systems. For certain circumstances this is absolutely necessary but developing this as an overall mindset in the industry completely strips away the humanity from the process, diminishing the fact that we are in the health “care” industry. Unfortunately many patient experiences involve being handed a prescription and shown the door before they can even fully explain their concerns. The human compassion and investigative process has been left behind in order to fulfill a set of checklists that might someday be compared to a clinical trial. Or even worse, directing patients to medicate in way that could exacerbate other chronic conditions in their life in order to follow the success rates of a homogenized trial.

We are complex beings with unique sets of circumstances. Your healthcare should reflect both your medical as well as your lifestyle needs. You cannot successfully treat one symptom only to find that it creates a domino effect of adverse reactions. While in some instances this might be a necessary step, it should be the exception not the rule. As practitioners we must all work together in order to achieve our one true goal. Your overall health and wellbeing.

Ask yourself the following when seeking a professional:

– Have I received an in depth consultation that looks at all of the elements in my life as a whole?
– Does this practitioner see me as an individual or as a number?
– Am I receiving customized care or being guided towards medication or surgery immediately?
– Do I have a gut feeling that there are other options to be considered before taking drastic measures?
– Would it benefit me to integrate both medical as well as alternative treatments in order to achieve wellness?

Knowledge is power. As patients it’s time to become an advocate for yourself. Become part of your own treatment plan, ask questions, discuss options, follow your gut when it comes to achieving your optimal state. That is not to say that medical measures should not be taken as they can be a necessary part of the process, but be aware that your well being calls for more than a 15 minute consult and endless amounts of medication. Take the time to research and truly invest in your health allowing yourself to discover what practices make you feel well balanced, regardless of whether it has been proven in a clinical trial or not. You are the proof. Remember that the art of medicine must reflect the needs of an endless amount of unique individuals and that sometimes the evidence- based medicine alone is simply not enough.


1- Fuller J, Flores LJ, Upshur RE, Goldenberg MJ. Renaissance or reformation for evidence based medicine? BMJ. 2014 Jul 30;349:g4902. doi: 10.1136/bmj.g4902.

2- Greenhalgh T, Howick J, Maskrey N; Evidence Based Medicine Renaissance Group. Evidence based medicine: a movement in crisis? BMJ. 2014 Jun 13;348:g3725. doi: 10.1136/bmj.g3725.

3- Oliver D. Evidence based medicine needs to be more pragmatic. BMJ. 2014 Jul 9;349:g4453. doi: 10.1136/bmj.g4453.