WHOOPS

Extremely misguided and unscientific recommendations by a recent New England Journal of Medicine, Nov 22, 2018, article suggests we move beyond evidence based medicine (EBM) to a new paradigm described by Thomas Lee, MD as "interpersonal medicine"(IP). The article describes the need for caregivers to respond to the individual circumstance and capabilities moving beyond EBM. While every caregiver already understands that tailored individual care is the hallmark of fulfilling the fiduciary obligation to every patient, we must redouble efforts to base those tailored decisions on a very strong foundation of objective science and EBM. We must decry the use of anecdotal and experiential care which risks offering therapies and interventions which offer no improvement over placebo but subject the patient to risk of harm without any proof that there is a benefit.

I applaud every effort to engage in shared decision making and encouraging patient engagement but only through EBM. We return to the days of snake oil and witch doctors when we move away from science and EBM. We currently do not practice EBM in the vast majority of patient encounters ( a fact admitted in the article) Please see previous articles I have written on the topic. The decades of work of Iaoniddis highlight that 85% of the published research is either biased, invalid or non-reproducible proves this. Understanding the importance of care coordination, psychological implications of the caregiver patient relationship, communication and understanding the impact of social determinants is critical but only if founded on EBM.

The author touts the benefits of "intuition" and "instincts" in care-giving which is frankly heresy and anathema. We have over thirty years of data proving that our medical instincts and intuition are more often wrong than right and that is why we need clinical decision support, artificial intelligence and other technology solutions so that science based decisions trump anecdotal medicine. The work of Kahneman highlights the cognitive biases which pollute objective decision making. When obtaining informed consent research shows that physicians routinely underestimate risks and overstate benefits when communicating with patients.

One major point of agreement is that science will not solve our biggest problems in health care but rather addressing prevention and the social determinants of health. I have written most recently on the benefits of social prescribing and link workers/community health workers as a evolving solution to preventative care. Still the practice of medicine should be EB, scientific, not intuitive, instinctive or anecdotal.

Creating good health policy should be based on science not anecdote. Patient surveys identify preferences but do not create cures for disease

Lets embrace

Shared decision making
Informed Consent
Enhanced communication
Prevention through the social determinants of health
Clinical decision support, artificial intelligence, technology
EBM

Lets de novo reject

intuition
instinct
anecdote based care
interpersonal medicine which moves beyond EBM