From the Guidelines
No, practicing the art of medicine does not stand in clear opposition to evidence-based medicine; rather, they complement each other. The art of medicine involves clinical judgment, empathy, and individualized patient care, while evidence-based medicine provides scientific foundation through research and data. As noted by Dr. Sackett, evidence-based medicine has two elements: the best external evidence and the individual clinical judgment of the clinician in deciding whether that evidence applies at all and, if so, how it has to be tailored to the individual patient 1.
Effective medical practice integrates both approaches by applying scientific evidence within the context of individual patient circumstances, preferences, and values. A physician might prescribe a treatment based on clinical guidelines (evidence-based), but may adjust this regimen considering the patient's unique situation, potential side effects, and personal goals (art of medicine) 1. This integration allows for personalized care that respects both scientific knowledge and human factors.
The best practitioners recognize that medicine requires both scientific rigor and humanistic understanding, using evidence as a guide while acknowledging that each patient's situation requires thoughtful interpretation and application of that evidence. As highlighted in a study on changing provider behavior in the context of chronic disease management, the intention of clinical practice guidelines is not to provide a rigid approach to diagnosis and treatment, but rather to facilitate a bottom-up approach that integrates the best external evidence with clinical expertise that considers individual patients’ goals, values, and preferences when making decisions about care 1.
Key aspects of this integration include:
- Applying scientific evidence to individual patient circumstances
- Considering patient preferences and values in treatment decisions
- Using clinical judgment to tailor evidence-based guidelines to unique patient situations
- Recognizing the importance of both scientific rigor and humanistic understanding in medical practice.
By combining the art of medicine with evidence-based medicine, healthcare providers can deliver high-quality, patient-centered care that improves outcomes and enhances the overall quality of life for their patients, which is the ultimate goal in terms of morbidity, mortality, and quality of life.
From the Research
Relationship Between Art of Medicine and Evidence-Based Medicine
- The art of medicine and evidence-based medicine (EBM) are not necessarily in opposition, as some commentators suggest 2.
- EBM is a necessary condition for clinical freedom, and it is not something to be balanced with clinical experience or patient preferences 2.
- The view that medicine is a science, reinforced by EBM, has led to a narrow understanding of science and a devaluation of the art of medicine 3.
Critiques of EBM
- Critiques of EBM often rely on erroneous understandings of the relationships between inductive knowledge, clinical uncertainty, and action 2.
- Some arguments against EBM are also defaults of "classical medicine", such as its negligence of social aspects of medicine 4.
- Both opponents and proponents of EBM use the same arguments against each other, maintaining that the other approach does not allow for physicians' autonomy and free judgment 4.
Role of Evidence-Based Practice in Healthcare
- Evidence-based practice (EBP) competencies are essential for healthcare professionals to provide quality care and improved patient outcomes 5.
- Practicing healthcare professionals' self-reported EBP knowledge, skills, attitudes, and beliefs are at a moderate to high level, but they do not always translate into EBP implementation 5.
- The development and adoption of an EBP competency set for all healthcare professionals is a priority, along with using validated outcome measures 5.