EBM Manifesto 2.0

What is good for Evidence-Based Medicine is also good for Evidence-Based Dentistry. Siblings separated by the vagaries of history and politics.test-004

Prof Carl Henehgan gave an inspiring but also worrying presentation titled “Resuscitating poor quality research”.  One conclusion of the presentation was that throwing more money at healthcare will not solve the problems we are facing at present. The two areas that come up most in UK conversations are general practice, be that medical or dental and A+E. These are both ‘wicked’ environments and I would recommend all policy makers to read Rittel & Webber 1973 paper. A ‘wicked’ environment is unstable and ever changing, full of unique problems and solutions. Over the year’s policy makers have increasingly tried to tame these environments which by their very nature morph into a new set of problems.

In my practice, we are increasingly distracted from our patients/staff care by new layers of policy that bare no relation to the practice we work in. The two things that I would recommend are firstly that we accept what these environments are, and will always be, impossible to fully tame. Secondly we don’t need to waste large amounts of time and resource creating universal detailed policies  to deal with every possible adverse event. By the time one problem is ‘solved’ it is already redundant and has been overtaken by a new problem.

Practice is like a dance, at its best we are in constant state of flow, dealing with the ever-changing situation. This is based on deep knowledge, experience, care and compassion, not tick-boxes. We need the autonomy and trust of the policy-makers to balance the care of the individual with the care of the population. Trying to centrally ‘manage’ every aspect with a policy document or guideline creates an adversarial battle ground increasingly resistant to change or improvement.

Webber, M.M. & Rittle, H., 1973. Dilemmas in a General Theory of Planning *. Policy Sciences, 4 (December 1969), pp.155–169.


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