NB-working text with dyslexia warning + Swedish text at http://stressmedicin.se/projekt/innovationer-och-utveckling-av-en-effektivare-varden/utmaningar-for-vardframtiden-normativ-evidens-vs-klinisk-ideografisk-evidens/)
An effective clinical focus requires models and practical real-world based methods where not only individual variations are point of departure but also in principle varying variations within and between individuals across situations and time. Which represent basics for clinical work – for clinicians as well as patients.
In addition, health care should address lifestyle related dysfunctions from a biopsychosocial perspective realistic paradigm, but which is something we hardly are not yet in the beginning of the beginning to developed, theoretical as well as practical. This despite the fact that most of us realize/recognize that reality (real world) is extremely complex and is something that medicine/psychology/psychiatry should be assumed to “work for” and not extreme too simple reductionistic paradigm – if we now assume that health care fields try to initially prevent, investigate/assess/diagnose and treat real world related development of dysfunctions – be it medical, psychological or psychiatric!
Impossible? Perhaps, but we should at least try to manage people’s lifestyle related dysfunctions/diseases/problems, as there is no other way to go – forward! Or?
Many barriers exist at the present time, political power elite’s incompetence, paradigmatic short-comings (hard to be based on reductionism..), methodological weaknesses to manage extremely complex processes with traditional evidence based rules and absence of biopsychosocial system-integrated medical/psychological/psychiatric assessment and intervention practical applied applications as well as a technological developing that often lacks the above necessary knowledge/practical platforms, but where the technology development (including AI) in itself represents great opportunities.
This imbalance can be managed in an untraditional, innovative way that I very briefly below not very clearly suggest, because it is likely to be patentable.
When it comes to evidence (central but to be questioned more than I do here), a concept/word which in no way is understood as absolute or high level knowledge, but incomplete, however, as the human brain have the capability to elaborate also imperfect knowledge, to a certain extent, it does can be carefully used integrated with complementary methodology/technology.
But here, I intend to focus only on the concept of clinical evidence! Normative studies are not effective at clinical levels although empirical normative sciences (which in theory should work empirically as falsification of hypotheses), it is often the normative based science, which “points with the whole power-hand what is the law to be followed”. At the same time, clinical work with “evidence-based thinking” via single-case design methodology and partly also through dynamic measuring systems (where possible direct or indirect) continuously monitor the initially interpreted a priori diagnosis prediction hypothesis (DPH) in the following intervention process as well as outcome measures. This makes it possible to modify the DPH (eg. George Kelly’s, 1955, formulates motivational reasons for such an approach) during the intervention processes.
Given (the above) also that the intervention is built up on the basis of “patient as educated, reasonably skilled resource and co-workers in their own rehab” (our version of group learning/training class-room education and, where appropriate, supervised coaching) because the practical and methodological approach enables to be more effective if the patient “is upgraded” to co-worker – NOTE based on each one’s reasonable potentials in the process – in my experience often positively surprises the patients themselves – a factor which I elsewhere also discuss based on a slightly modified definition of the concepts of the placebo and nocebo!
My way of using DPH and single case design is summarized in the IBED method, Individual Biopsychosocial Evidence based Documentation … will more here text a head …
NOTE that the above is more an appetizer than scientific and clinical information, above motivated why! Those interested in more info can email to firstname.lastname@example.org