While Evidenced Based Medicine is not enough effective in clinical work

The below is working text (can perhaps be named “a clinical sociological issue”) just started – more will come ….

At least three basic limitations prevent effective clinical medical health care (except organizational problems including leadership, political and economic interferences and ambitions …)

  1. Normative evidence of patients (here focusing on lifestyle) medicine diseases and mental problems mostly suggests very little, if any specifics, about a certain patient, while they vary between and within over situations and time. Clinical appropriate knowledge development and empirical studies requires careful biopsychosocial individuals based examinations (ideographic level, e.g. a priori predicted single case designs where patients are their own control is one version) and then “move up” to normative (nomothetical) levels.
  2. Moreover, concerning the scinetific/clinical individual, pronounced variation occurs at “both/opposite side” while clinical providers “normally” vary concerning clinical professional competences including personality characteristics where caring suitableness is critical but not much enough address in clinical education – always. http://ps.columbia.edu/education/node/1952
  3. A third aspect needs to be added (need to be work on although this is normally not paid much attention to). Very needed empirical studies can not be done at al by a number a number of reasons, where one is the number of systems (and its possible parameters) are so complex (and many assumed not even known) that any investigation can be done – only more or less try to guess, or the variation between and within over time and situation as well as present knowledge limitations (addressed above but need to be integrated here also) are so pronounced that it is not possible. Sadly, this is then address from a commercial point of view, e.g. diagnosis of hypertension or DSM X criteria for e,g, ADHD or …

The above create complex problems not well dealt with in health care systems work. This influence largely efficacy at many levels, which is not easy to reveal and substantially manage. Many shortcomings associated with structural problems may ta varying parts be related to lack of efficacy in managing patients and clinical providers´ variations.

Although this is recognized at least since Hippocrates not much progress in “treating” this problem has been developed.

Why not managed well while, both individuals and societies are losers. A number of scientific paradigmatic, methodological, educational, social …  reasons can be recognized we can ask us “to we have during thousands of years addressed/address those critical issues enough”?   It concerns real world problems for all – or perhaps most of us at individual, organizational och society levels! What does politicians say? Do the realized the problem expressed in the above way? Can science itself contribute with solutions?

What kind of solutions is possible to the above?

One is that we need to build knowledge from single cases and  move upwards instead of guess how normative knowledge can be attributed to Hans or Great – go from ideographic to nomothetic levels!

But to increase lifestyle related health in humans can only be done thorough learning while doing while understanding while observing while … be motivated by the results related to own doings! That is, mass-education (in Swedish we have a special tradition which facilitated it is use) like we have done clinically for 25 years (based on my dissertation 1986) “patient as educated, competent resource and coworker in her/his own rehabilitation” using a biopsychosocial medicine toolbox. E.g. hypertension patients get happy when they SEE and LEARN (while seeing) what they can to. “Ahhhaaa, that is me doing …. ” can move mountains!

Freedom to do what ever you what is a complex matter. Most societies have restrictions here based on culture, e.g. in many countries you may not end you own life directly but you can do it over time doing behaviors that kill yourself over time.

One way is to reward health behaviors BUT also those who gradually change from destructive to constructive! Those who believe they can not the change get help! If needed force which they themselves realize they need for a while to pass critical thresholds! Everybody wins! Hard to get political support for?  Something to work on!

In democratic societies we live in a over manipulated context. Restrict this in a for all constructive direction! Why let profit interests manipulate people! Really not win-win! When a colleague suggested a politician “work for better healthy food in schools” the answer was “this is no good way to be reelected” – what is the goal? To be reelected or do things that we understand is important!

More ideas? Our grand grand children can not wait anymore/any longer for internalization of constructiveness!

More will come – I hope