By Victor M. Montori
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In such patients, who would tell us they want the physician to make the decision on their behalf, the physician’s responsibility is to develop insight to ensure that choices will be consistent with patients’ values and preferences. Understanding and implementing the sort of decision-making process patients desire and effectively communicating the information they need requires skills in understanding the patient’s narrative and the person behind that narrative (14,15). A continuing challenge for EBM—and for medicine in general—will be to better integrate the new science of clinical medicine with the time-honored craft of caring for the sick.
AMA Press, Chicago, IL, 2002. 15. Guyatt G, Sackett D, Taylor DW, Chong J, Roberts R, Pugsley S. Determining optimal therapy— randomized trials in individual patients. N Engl J Med 1986;314:889–892. 16. Guyatt GH, Keller JL, Jaeschke R, Rosenbloom D, Adachi JD, Newhouse MT. The n-of-1 randomized controlled trial: clinical usefulness. Our three-year experience. Ann Intern Med 1990;112:293–299. 17. Larson EB, Ellsworth AJ, Oas J. Randomized clinical trials in single patients during a 2-year period.
45. Armstrong D. Clinical autonomy, individual and collective: the problem of changing doctors’ behaviour. Soc Sci Med 2002;55:1771–1777. 3 The Philosophy of Evidence-Based Medicine Gordon H. Guyatt, MD, MSC and Jason W. Busse, DC, MSC CONTENTS INTRODUCTION TWO FUNDAMENTAL PRINCIPLES OF EVIDENCE-BASED MEDICINE CLINICAL DECISION MAKING: EVIDENCE IS NEVER ENOUGH A HIERARCHY OF EVIDENCE CLINICAL SKILLS, HUMANISM, SOCIAL RESPONSIBILITY, AND EVIDENCE-BASED MEDICINE ADDITIONAL CHALLENGES FOR EVIDENCE-BASED MEDICINE REFERENCES INTRODUCTION This chapter is drawn largely from a chapter in another book, the Users’ Guide to the Medical Literature (1).