By Elena Rocca
Pharmacology is a complex science that aims to balance harm and benefit of treatments for the individual patient. How should different types of evidence be synthesised in order to optimize this task? Should evidence from randomized trials be prioritized over other evidence, following the EBM model? If not, how can different types of evidence be amalgamated in an alternative way? (more…)
Karin Engebretsen, Thinking about guidelines:
The question that is still with me after the workshop is how the naturalist paradigm might affect the “political correct” attitude towards patients suffering from medically unexplained syndromes.
If the political decision makers within the medical field believe in the biomedical model as the provider of the best medical practice, their “worldview” will automatically, influence the complete medical system.
The biomedical model excludes psychological and social factors and includes only biological factors in an attempt to understand a person’s medical illness or disorder. Thus, the biomedical model have a limited, reductionist attitude that divide the human body into separate elements focusing on biological factors. Patients often seem to have a unique expression of their symptoms and a unique combination of biological, social and psychological overlapping symptoms. So how do reductionism and dualism affect clinical guidelines and diagnosing related to medically unexplained syndromes?
I see this question as related to ethical issues in medical practice and I hope there will be more focus on this fact as a critical mechanism.
Elena Rocca, Thinking about guidelines:
I was interested in a question that Sietse threw at us many times: what should be the purpose of a guideline? What does “helping to make a good decision” mean?
We got some inputs about it throughout the whole day: it might mean including the patient view, or reporting only the evidence with no recommendation, or giving recommendation but being transparent about which evidence was considered and how it was judged, or again, as Sietse suggested, it might mean to explain what is “to make an inference”, what happens when a clinical decision is made. I was particularly interested in this last suggestion, and I felt it remained a bit “in the air”. Does it mean that we would need a guideline about the decision process? About the implicit and sometimes unaware stand that the clinician takes by valuing one or the other evidence, following the guideline versus personal judgement?
It is an exciting spring for the CauseHealth project. In January, we organised the N=1 workshop here at NMBU. And in May and June our partner institutions will host a conference in Nottingham and a one-day symposium in Madrid. (more…)
By Neil Maltby — author of the becomingmorehuman blog, a physiotherapist in the UK, and a CauseHealth collaborator
She seemed straight forward enough on assessment. 45yrs old. Sudden pain onset from a seemingly innocuous movement many years ago. Episodic but progressive back pain since. Almost full range of movement. No significant neurological, inflammatory, vascular or other suspicious signs. One thing did sit in my mind though. It was as I asked her to reach down to the floor. (more…)