Philosophy for medicine: applications in a clinical context

[摘要] One of the problems that modern medicine struggles with is that the facts don't tell you what to do. The problem is undiminished and perhaps even exacerbated by the rise of evidence-based medicine (EBM). EBM has given us more facts, and better facts about the work that we do. However, as David Sackett and others have cautioned, evidence always needs to be interpreted by a clinician for a particular situation conscientiously, explicitly and judiciously. Evidence, and derivations of evidence like guidelines, are not self-interpreting. It is not unusual now, at least in our area, for GPs to have to rescue the over-90s from the dubious benefits of drugs like statins and antihypertensives started injudiciously (although with best of intentions) by junior medical staff in hospital. Drug-induced iatrogenic problems are now a major cause of morbidity and admission to hospital, especially in the elderly, yet as doctors, we seem to have a persistent belief that, as far as drugs are concerned, more is better. We need to keep remembering that the patient in front of us, as Jonathan Rees says, was not in the trial. Or, as David Hume said in 1740, you can't derive an ‘ought’ from an ‘is’.1a

[学科分类] 卫生学