| Epistemology and ethics of evidence-based medicine: putting goal-setting in the right place. | |
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MedLine Citation:
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PMID: 20367852 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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While evidence-based medicine (EBM) is often accused on relying on a paradigm of 'absolute truth', it is in fact highly consistent with Karl Popper's criterion of demarcation through falsification. Even more relevant, the first three steps of the EBM process are closely patterned on Popper's evolutionary approach of objective knowledge: (1) recognition of a problem; (2) generation of solutions; and (3) selection of the best solution. This places the step 1 of the EBM process (building an answerable question) in a pivotal position for the understanding of the whole process, and underscores a few aspects which are often overlooked in EBM courses. First in this step internal evidence (including personal expertise) must be appraised and integrated in the problem. Second, issues of applicability of the possible solution should be anticipated. Third, and possibly more important, the goal of the intervention should be set at this stage (typically by choosing the outcome in a PICO question). Depending whether or not goals depend on the goals of others, and whether they concern others' voluntary behaviour, goals may be classified as self-serving, moral, altruistic or moralistic. Thus, delicate ethical questions must be addressed at this stage, which means that patient preferences and values must be carefully sought, so that empathy, counselling and narrative medicine must be mastered to be able to formulate correctly an answerable question. The need to modify the current description of the EBM process to increase the recognition of implicit assumptions and increase the consistency of this model is discussed. |
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Authors:
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Piersante Sestini |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of evaluation in clinical practice Volume: 16 ISSN: 1365-2753 ISO Abbreviation: J Eval Clin Pract Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-04-06 Completed Date: 2010-07-29 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9609066 Medline TA: J Eval Clin Pract Country: England |
Other Details:
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Languages: eng Pagination: 301-5 Citation Subset: IM |
Affiliation:
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Department of Clinical Medicine and Immulological Sciences, Section of Respiratory Diseases, University of Siena, Siena, Italy. sestini@unisi.it |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Education, Medical Evidence-Based Medicine / ethics* Goals* Humans Knowledge* |
| Comments/Corrections | |
Comment In:
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J Eval Clin Pract. 2010 Apr;16(2):306-9
[PMID:
20367853
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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