Lately it has appeared en vogue to criticize the evidence based practice movement in physical therapy. While it can be argued that there are a lot of things wrong with evidence based practice, many of the prevalent criticisms on social media seem to stem from limitations in understanding of what evidence based practice is rather than actual shortcomings of evidence based practice itself.
When did the evidence based-clinician become synonymous with being a thoughtless data driven robot?
This is a significant misunderstanding of what evidence based practice is. Evidence based practice requires “clinical expertise for producing and interpreting evidence, performing clinical skills, and integrating the best research evidence with patient values and circumstances.” This inherently can not be thoughtless. If you are blindly applying sample data to individual patients, you are not practicing in a manner that is consistent with real evidence based medicine.
Why is there a misconception that evidence based practice and science stymie creativity and innovation?
Some of the greatest innovations in medicine came not from a miraculous a-ha moment, but a tireless dedication to the scientific method. After all, ”Jonas Salk did not find a cure for polio using intuition. He used reason and the scientific method” — Noson Yanofsky
Where does the idea that predictive modeling puts clinicians on autopilot and removes all thought from clinical practice come from?
It doesn't. In fact, it improves our ability to do our jobs. Airplane pilots have extensive checklists that they follow to reduce the risk of catastrophic events. This does not mean that pilots do not think or that they are any less skilled at what they do. What it does mean is that they have recognized the limitations inherent in their ability and have developed strategies to improve upon them. The same should be true for physical therapy practice. Clinical gestalt is simply not good enough.
Why do some clinicians believe that evidence based practice comes at the expense of empathy?
The idea that clinicians sacrifice empathy in lieu of robotic adherence to evidence based practice is baseless. We as a profession have enough trouble adopting science and research to have evidence based practice be a potent driver of stunted empathy. If empathy is absent and patient values are not integrated into clinical care this is a fault of the clinician, not a shortcoming of evidence based practice.
What does evidence tell us about our ability to provide client-centered care?
Qualitative assessments of the patient experience in rehabilitation are not pretty. Clinicians are described as “coercive; domineering; manipulative; hierarchical; cold; distant; disempowering; accountable to employers rather than to clients; indifferent to clients as human beings; willing gate-keepers to the equipment, resources, and services clients need; and sharing a pessimistic, deflating ethos.” This contradicts the assumption that we consistently provide a client-centered rehabilitation experience. Such evidence is necessary to highlight the limitations in our practice and to challenge us to address them. It is science that informs us we need to improve our listening and our empathy. It is research that tells us that contextual factors matter.
There are a lot of problems with evidence based practice in physical therapy. But, if we as a profession have difficulty with being client-centered, it is not because we are too concerned with following the research. By improving our understanding of what evidence based practice is and is not, we can work towards recognizing our own shortcomings as a profession and create novel ways of addressing them.