Evidence-based Medicine: A Framework for Emotional Regulation, Intuition, and Conscious Engagement

Abstract

Editorial EdItORIAL " Without clinical expertise, practice risks becoming tyrannized by evidence. " —David Sackett 1 E ven though most people—including scien-tists—use intuition every day, clinicians are advised to stick with evidence-based medicine and for the most part steer clear of spirituality, con-sciousness, and intuition. This is changing as scien-tific evidence emerges to support the notion that the practice of good medicine includes attention to these factors. In fact, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the organiza-tion that sets standards for healthcare institutions, requires organizations to include a spiritual assess-ment as part of the overall assessment of patients, 2 an acknowledgement that both science and spirit pro-vide important contributions to optimal health. As health and wellness emerge as healthcare priorities, there is recognition that spirituality and science are not mutually exclusive. It helps that there is a body of science that point to benefits of spiritual-ity on health. Associations have been found with reductions in mortality, hypertension, HIV progres-sion, cognitive decline in Alzheimer's disease, sub-stance abuse, gambling, depression and anxiety, and more. 3 Yet randomized controlled trials and system-atic reviews, the arbiters of evidence designed to evaluate pharmaceutical drugs and medical devices for specific indications, are the dominant focus in today's healthcare system. Evidence-based medicine is immensely important in bringing science to the bedside. It involves a power-ful four-step framework in which healthcare providers (1) frame the right clinical questions to begin with, (2) find the best available scientific research to answer those questions, and then (3) evaluate and (4) apply the research to make the best possible healthcare deci-sion with their patients (Figure). The process in clini-cal practice then loops back to frame the next ques-tion: " How did that work out? " 4-6 While evidence-based medicine helps us apply scientific answers to address our health concerns, this alone may not be enough to facilitate our experience of optimal health and healing. Indeed, the reliance on databases, electronic health records, and other forms of technology has the potential to sterilize the physi-cian-patient interaction. If a sense of wholeness and one's spirituality is related to the experience of health and well-being, how do we include the willingness to be inspired, to open our hearts and feel compassion, and to experience love, hope, forgiveness, inner peace, stillness and comfort? One of the pioneers in evidence-based medicine, Archie Cochrane, recognized that science alone was not enough. In his book, One Man's Medicine, 7 he shared how as a doctor in a prisoner of war camp he cared for a dying patient who he initially believed was screaming in pain from pleurisy. With no medica-tions at hand to care for the patient, he simply held the patient in his arms and noted that the screaming stopped almost at once. He recognized that loneliness, not pleurisy, was likely the cause of the screaming and that the needed balm was love and compassion rather than morphine. So how can we become more conscious about integrating a spiritual dimension, love and compas-sion, with science on the journey to health and well-being? After writing a textbook on evidence-based medicine, 5 I dedicated more than a decade to training healthcare providers in this practice and then began to slip into despair. For me, the science-focused approach I was teaching represented the mind of medicine and I was sorely missing the heart of health-care from my earlier work around healthcare provider resiliency and well-being and the compassionate delivery of healthcare. Five years ago, while putting my 4-year-old son to bed and restlessly contemplating my career path, I had a life-changing event. A question popped into my mind: " How can I find my way home? " And in that very moment I found a sense of peace and calm I had never experienced. In reflection, I realized that all I had done was to ask a better question. Instead of self-critically asking, " How could I have veered off track? " I had asked a self-compassionate question, " How can I