Trish Greenhalgh and Neal Maskrey
Trish Greenhalg is Professor of Primary Care Health Sciences and Fellow of Green Templeton College at the University of Oxford. She has twice won the Royal College of General Practitioners Research Paper of the Year Award and in 2001 received an OBE for services to Evidence Based Medicine.
Neal Maskrey is an Honorary Professor of Evidence-informed decision making at Keele University and consultant clinical adviser in the Medicines and Prescribing Centre, National Institute for Health and Care Excellence, UK.
In this video, these experts explain the concept of real evidence based medicine (EBM) as it should be applied to real patients.
Note particularly 6.30 to 7.47
. . . if you look at the research literature on expert judgement you will find that experts . . . don’t mechanically follow rules. They do something much more intuitive and much more rapid and what they then do is they come to a rapid decision and then they go back and unpack why they got to that decision and they justify it by using the evidence . . . one of the things that clinicians say again and again is “I don’t want to be tyrannised by these guidelines. I don’t want my patients to be tyrannised by these guidelines.” And it seems that their clinical judgement is being challenged by these guidelines and what we want is for the clinical judgement to be supported by the guidelines so EBM will be delivered in a much more nuanced and granular way than people sometimes assume it should be.
Also 7.57 to 8.30
There are, of course, in every consultation two people involved in making the decision. The clinician has their own expertise and the patient has their own expertise.
How sad that, while the rest of the world is reassessing the concept of Evidence Based Medicine, Singapore is taking the backwards step of applying the guidelines in exactly the mechanical way that these experts feel should be avoided!