When patient-centeredness and evidence-based medicine collide
R Scott Braithwaite
Division of Comparative Effectiveness and Decision Science, New York University School of Medicine, New York, NY, USA
Abstract: There are numerous clinical situations in which inferences from evidence-based medicine conflict with patient-reported outcomes or experiences. For example, a patient may report better symptom relief from a drug which has been demonstrated in randomized controlled trials to be non-superior to its competitors. Such conflicts have often been cast as tensions between "the art of medicine" and the "the science of medicine". However, we add to the current evidence-based literature by asking whether many current distinctions between "the art of medicine" versus the "science of medicine" are not best explicated in those terms after all, but rather are proxy terms for whether internal validity or external validity are more important in a particular situation. In addition, we outline one possible framework for systematically determining whether evidence is generalizable in a particular clinical situation. Limitations to this approach are emphasized, as well as steps forward that would make use of published but underutilized methods.
Keywords: art of medicine, science of medicine, internal validity, external validity, patient-reported, generalizability
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