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Reflecting on Evidence Based Medicine, Person Centered Medicine and Small Area Variations: how contemporary frameworks for medicine address (or not) the needs of the individual patient

Mathew Mercuri, Amiram Gafni


Over the past few decades the medical literature has given much attention to three movements: Evidence Based Medicine (EBM), Person Centered Medicine (PCM) and Small Area Variations (SAV).  Each claims to provide a framework for improving the care of individual patients. This paper examines why attention to the individual patient is important in the provision and delivery of healthcare and how each of these movements seek to address individual patient needs. We suggest that EBM, PCM and SAV all suffer from a number of issues that render their use as a framework to address individual patient needs inadequate. In the case of EBM, it is a reliance on (at best) population level study (e.g., clinical trials) that do not necessarily translate to individual patients. PCM appears to recognize the information requirements to care for individual patients, but is unclear on how that information can be obtained. Likewise, SAV is limited in that its methods do not discriminate between warranted and unwarranted variation and its reliance on the EBM approach in assessing what is the correct treatment for patients. This paper concludes that EBM, PCM and SAV are not solving the problem of how to provide care for individual patients. While we do not offer a solution here, it is only when we admit we do not have the answers to this problem that we can begin to look for a solution.


Evidence Based Medicine, medical practice, patient context, Person Centered Healthcare, philosophy of medicine, variations

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