Because so little evidence stands on its own, incorporating research results into clinical practice requires discernment. Thoughtful doctors consider data, accompanying narrative, plausibility and, yes, clinical anecdote in their decision making. To put the same matter differently, evidence-based medicine, properly enacted, is judgment-based medicine in which randomized trials, carefully assessed, are given their due. I don’t think that psychiatry — or, again, medicine in general — need be apologetic about this state of affairs. Our substantial formal findings require integration. The danger is in pretending otherwise. It would be unfortunate if psychiatry moved fully — prematurely — to squeeze the art out of its science. And it would be unfortunate if we marginalized the case vignette. We need storytelling, to set us in the clinical moment, remind us of the variety of human experience and enrich our judgment. How far should stories inform practice? Faced with an elderly patient who was anxious, withdrawn and never medicated, a well-read doctor might weigh many potential sources of guidance, this vignette among them. Often the knowledge that informs clinical decisions emerges, like a pointillist image, from the coalescence of scattered information.
Posted on: Tue, 21 Oct 2014 10:49:02 +0000
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