Abstract

YouTube link: https://youtu.be/YiBXqfTzwEA

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Medicine aims at recognizing and treating various illnesses whilst taking into consideration the patient’s concerns, preferences, and expectations. As a form of applied science, it uses insight and methodologies from both the natural and social sciences. In the developed world, over the last two decades evidence-based medicine or EBM has become the dominant paradigm to help us choose between diagnostic and treatment options. The objective of EBM is to replace intuition, anecdotal evidence, or subjective clinical experience with the examination of objective evidence from clinical research, using formal rules to appraise the available evidence. The gold standard of EBM is the randomized controlled trial or RCT . However, there are two important points to make here: first, many treatments are still not evidence-based, as the evidence base just does not exist in the format required by EBM , and second, EBM can guide us about the efficacy and safety of diagnostic and treatment interventions but is silent about the personal importance attached to these by patient and doctor, i.e. their relevant values. This may be fine, e.g. when there is no choice, but in clinical practice that is rarely the case. To address this, another important, complementary framework of clinical theory and skills, called values-based practice (VBP), has been developed to help doctors and other team members from various disciplines to negotiate the inherent value diversity in healthcare when applying the science in clinical practice. The objective of VBP is to facilitate a good process whereby the (often conflicting) values involved in clinical decision making can be recognized and balanced productively. VBP draws on psychology, sociology, anthropology, and law, and – to navigate this complexity – philosophy. In my talk, I will illustrate with examples how examining the personal history of the patient, the doctor, and the history of the profession can be an excellent way to explore values relevant to clinical decision making.