Thread by @NatsforDocs

Some thoughts: There seems to be an assumption in #medicine that patients receive the best care based on best evidence, where evidence usually means quantitative research (my assumption). Yet quality of care is dependent on personal characteristics of each health professional 1/

Knowledge derived from evidence is insufficient to translate into behavioural changes that support the 'best care' intention. Science-based evidence must be channeled through unquantifiable characteristics expressed by each individual health professional to provide best care 2/

These characteristics include: empathy, kindness, unconditional positive regard, non-judgemental attitude, empathic listening, intuition, warmth, encouragement, hope and so on. If we're touting science-based medicine, it must also include practice-based evidence 3/

prof'l wisdom, patient values & ethics otherwise we're sending a message that knowing stuff is more important than demonstrating personal qualities known to support healing/recovery. Empathy, compassion, kindness can't possibly be standardised. People can't be standardised 4/

Patients can't be standardised. All evidence requires good clinical judgement & wisdom to apply to the patient's unique, non-replicable situation. The only way to develop wisdom is through experience + process for evaluating outcomes of decisions/reflection. 5/

Sometimes the information needed to provide 'best care' to the patient comes in the moment through self-awareness, Gestalt or hunch. There's no prior evidence base for it yet it's the most clinically relevant for that patient in that context. CONTEXT matters. 6/

We need to make room for the discoveries that can be made in the moment when it's needed most yet can't be found in journals. Science-based medicine provides the framework for care & its successful implementation depends on the creativity of individual health professionals. 7/

This is what's meant by the Art of Medicine. Art & Science must work together for best care otherwise healthcare will be taken over by robots who lack the power of human touch.
We must get over our addiction to needing certainty, when uncertainty & change are constants. 8/

It's time to put as much value in research dedicated to exploring and understanding the art of medicine to understand how our personal qualities/characteristics + unbiased research evidence promote healing, wellness, building capacity, confidence & thriving through life too. 9/

If wellness is the goal, we need to focus on generating evidence of wellness in patients & influence in alleviating symptoms of illness instead of only studying illness aiming to decrease it. Focus on what we want in order to see more of it or we remain stuck in the problem. 10/

In summary: science-based evidence + practice-based evidence + patient values &characteristics + professional wisdom + ethics + professional characteristics/qualities/skills + context = best practice. It ain't easy. Let's take it easy on each other. @MasterUrWords #medtwittter