EBM snobbery

Prior to finding myself as a freelancer (that's what I'm calling myself this week), I spent a bit over a decade working in hospitals. There are lots of really great things about spending your early career in hospitals. It is an amazing learning environment. But over that decade I started to get the impression that it was a bit of a mono-culture. Part of that I think is to do with the industrialisation of hospital services that grew in response to the medication safety movement. This created a shift (at least in pharmacy) from having a workforce which valued clinical decision making to one that relied upon policies, procedures and meeting KPIs. Alongside this was the rise to dominance of evidence based practice.

I'm not for one minute saying that EBM is not important. I think it's essential to form the foundation for effective health policy. I just think many people have made it out to be synonymous with best evidence (scientific studies, usually confined to quantitative RCTs) and forgotten the other bits. And those other bits, patient preferences, clinical judgement, and 'lower quality evidence' like qualitative studies, are vitally important to effective clinical decision making.

This morning I was reading about the challenger disaster (in Range by David Eppstein). Narrowly focusing on the quantitative data, discounting the qualitative data and available expertise resulted in the death of seven people. There existed a culture that discouraged problem identification, and failed to build environments that encouraged discourse. A culture where sticking to the defined procedure, even when it might not be appropriate, seemed more defensible than risking looking foolish to upper management by discussing the 'soft' data and human concerns.

This reminded me a lot of the hospital environment. I bet a lot more than seven lives have been cut short because of the same issues.