Ersatz Individuality

Evidence-Based or Patient-Centered?

Two important concepts in healthcare are fitfully coming together and sometimes seen as being in conflict — evidence-based care and patient-centered care.

In a passionate commentary, cardiologist Sandeep Jauhar laments that “variation has become a dirty word” in American medicine today. While acknowledging that some degree of evidence-based standardization makes sense, he pleads that we should begin to personalize, rather than homogenize medical care. He concludes that:

Neither the old approach, in which seemingly every patient was treated differently, nor the new one, where we try to treat them all the same, has worked well. Medicine needs another way.

No one understands this dilemma better than obesity medicine physicians. Donna Ryan and colleagues labored for five long years to produce new obesity treatment guidelines published barely more than a year ago. Far from being a cookbook, the new guidelines address five core questions through evidence analysis for obesity care.

Patient-centered care lies at the heart of good practices in obesity medicine. Motivational interviewing is an evidence-based practice that puts the patient at the center of his or her own care.

Writing in Sociology Compass, Loes Knaapen proposes that the sociology of standards can provide a framework for bringing patient-centered values into evidence-based medicine. She says:

Including “the patient” in EBM’s tools raises a host of questions about who is the patient (representative, lay, and public), what to include (patient preferences, collective values, and experiential knowledge), how to include it (quantification or participatory procedures), and to what end (democracy, quality, and acceptance).

Bottom line: good medical care is grounded in evidence and focused on individual patient needs.

“Never permit a dichotomy to rule your life.” — Pablo Picasso

Click here for Jauhar’s commentary, here for a review of the evidence for motivational interviewing in promoting health behaviors, and here for Knaapen’s paper.

Ersatz Individuality, photograph © Arko Sen / flickr

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