RRR Plus: Theme Healthcare improvement science


On Thursday the 26th of May 2016, we welcomed Prof. Trish Greenhalgh, professor of Primary Care Health Sciences Oxford University, Director of the Interdisciplinary Research in Health Sciences centre in Oxford, for a seminar in the Radboud Research Rounds (RRR) Plus series.  She gave an inspiring presentation on ‘Real Evidence Based Medicine and how to achieve it’.

On twitter, using the hashtags #RubbishEBM and #RealEBM, but also by publicizing in renowned papers such as the British Medical Journal prof. Greenhalgh has started a discussion on the shortcomings of Evidence Based Medicine, but also proposes alternatives to counter these shortcomings. By stating a number of examples she sketched the gap between results of research under controlled circumstances and its application in a complex reality wrought with uncertainties. The translation of generalized knowledge back to the concrete situation, context and experience of an individual patient is still difficult.

Defining features of #RealEBM are, according to prof. Greenhalgh: making the ethical care of the patient its top priority; demanding individualized evidence in a format that clinicians and patients can understand; is characterized by expert judgment rather than mechanical rule following; Shares decisions with patients through meaningful conversations;  applying these principles at community level for evidence based public health.

With 6 biases against the patient and 6 recommendations to counter these prof. Greenhalgh advocated a return of context to research and application of results. The methods and principles of EBM are not enough to address all the questions. Other research methods are needed to fill the gap. Prof. Greenhalgh called for a renaissance movement in Evidence Based Medicine: ‘There is a huge potential for EBM to work with other disciplines so as to enrich its continuation to human health and well-being’. The challenge for EBM is to combine knowledge from clinical epidemiology with knowledge from other disciplines, such as for instance sociology and philosophy.

Greenhalgh T et al. Six ‘biases’ against patients and carers in EBM. BMC Medicine 2015
Greenhalgh T et al: An open letter to The BMJ editors on qualitative research. BMJ 2016 

During the drinks the audience had the opportunity to continue informal discussions with Prof. Trish Greenhalgh. 

Interview during the college tour by Pim van Assendelft.

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Seminar and drinks.

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