Viewpoint: envisioning the successful integration of EBM and humanism in the clinical encounter: fantasy or fallacy?

Some authors challenge the dominance of evidence-based medicine (EBM) in current medical practice because of its tendency to disregard the patient in the clinical process and thus distort the clinician's view of the patient as the primary focus. This tendency to "scientize" the clinician-patient encounter threatens to seriously reduce the role of humanistic elements in medicine. Although the pendulum shift toward the epistemology of EBM is worrisome, it is only one aspect of the problems facing modern medicine in the process of discovering-or rediscovering-the human dimension in medical care. The author uses his own and others' interpretation of the philosophy of an underappreciated thinker, Michael Polanyi, as a springboard to envision the research required for the development of models of medical education and clinical practice that appropriately acknowledge both EBM and humanism. Striking the right balance between these two elements will require much additional research, but those who simply demonize EBM as the major barrier to humanistic practice fail to appreciate the essential role for critical thinking in responding to the demands of patient safety and health care quality. All may agree that the current medical landscape needs immediate attention but this author argues that such work needs to use the available tools such as EBM and Polanyi's Theory of Tacit Knowing as well as products of future research efforts. Failure to do less will prevent us from reaching the ideal of a truly humanistic encounter firmly embedded in practices that maximize patient safety and health care quality.