Trish Greenhalgh and Neal Maskrey on getting back to real evidence-based medicine

Posted by Biome on 27th June 2014 - 5 Comments


Since the idea of evidence-based medicine was first formulated over 20 years ago, this paradigm has seen numerous successes in improving patient care, based on the synthesis of high quality clinical research combined with medical expertise and patient wishes. However, concerns have arisen over some of it’s unintended consequences, from misappropriation of this term, to issues around the accessibility of the wealth of data being produced.

In an effort to stimulate debate over how these concerns can be overcome, Trisha Greenhalgh from the Bart’s and the London School of Medicine and Dentistry, UK, Neal Maskrey from Keele University, UK, and colleagues have launched a campaign for ‘real evidence-based medicine’, as announced by Greenhalgh at the 2014 Health Services Research conference hosted by BioMed Central and published in their article in the British Medical Journal (BMJ. 2014, 348:g3725). In this video Q&A with Greenhalgh and Maskrey, they explain more about the campaign, discuss the key problems with current evidence-based research, and explore the role medical education has to play.

 

“Real evidence-based medicine doesn’t replace compassionate, individualised care with a standardised one size fits all management protocol. [...] It’s about making expert clinical judgements in conversation with patients taking account of evidence.”
Trish Greenhalgh, the Bart’s and the London School of Medicine and Dentistry

 

Trish Greenhalgh is actively engaged in primary healthcare research at the interface between sociology and medicine, as well as holding a position as a non-principal general practitioner. She received her medical degree at Oxford University, UK, before pursuing a career in laboratory science and later retraining as a general practitioner. Upon joining Barts and the London School of Medicine and Dentistry, Greenhalgh set up the Healthcare Innovation and Policy Unit within the Centre for Primary Care and Public Health, where she takes an interdisciplinary approach to probe complex, policy-related issues in modern healthcare.

 

“In every consultation there are two people involved in making the decision. The clinician has his own expertise and the patient has their own expertise. What we want to see is a rebalancing of that power in those conversations.”
Neal Maskrey, Keele University

 

Neal Maskrey’s career began in general practice, before he went on to become a medical manager, and later Director of the National Prescribing Centre and Programme Director at the UK National Institute of Health and Clinical Excellence (NICE). Maskrey is now Professor of evidence-informed decision making at Keele University, UK, and a consultant clinical adviser in the NICE Medicines and Prescribing Centre.

 

  • Hazel

    This is the best Friday link yet. Treating your patient as a person has got to be the way to go. But I wonder, am I hypocritical to agree that someone is entitled to refuse a test or treatment, even if the guidelines support it, when if they want something that the guidelines say they don’t need, (or, more controversially is too costly) then that patient choice is denied?

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  • Johnathan Doe

    Unfortunately, most “guidelines” are not the result of EBM but are instead the result of consensus of experts, most of whom have a financial conflict of interest. A quick method to determine if a doctor is using EBM as a tool is to inquire about the absolute risk reduction of any given treatment. If a doctor insists upon using the relative risk reduction, I question their knowledge and decision making.

  • Loretta

    Clinicians need guidelines to assist with their clinical judgment in making clinical decisions. For some areas of research, evidence is either lacking or of low quality, hence the guidelines have to be generated with expert consensus until the high level evidence becomes available that can support the recommendations for practice. The guidelines have to start somewhere, I agree they may not be based on high level evidence but until it becomes available guidelines still need to exist.