Why, in medicine, evidence is still more important than narratives or values? Or “The importance of being evident.”

Abstract

The importance of being evident is what counts for medicine. The diagnosis must be evident and the treatment must be based on evidence. If that evidence is and always must be based on statistics, as we have seen, it becomes questionable. Evidence is good when it is robust and when it fits the individual patient. Only then does evidence-based medicine (EBM), make sense and only then the patient can be sure to be treated in the best possible way. EBM, the movement of medicine that is strictly based on evidence which is judged in a hierarchical order, is under scrutiny and heavily criticised, chiefly because it has lost the patient out of its focus. Numbers are more important than the individual diagnosis and treatment is administered according to population-based statistics and not ‘made to order’. Although this criticism is very valid, the solution cannot be to simply replace EBM with something else, but the solution must be to still base medicine and medical treatment on the best available evidence we have, while putting the patient back into focus. In order to do so, it is important to topple evidence hierarchies, to divide EBM into research and practice and to acknowledge that sometimes the statistical best evidence is not the best evidential treatment for the actual patient.