[Does evidence-b(i)ased psychiatry have its limitations?]

Area of Science:

• Medical Ethics
• Clinical Practice Guidelines

Background:

• Evidence-based medicine (EBM) is a clinical decision-making framework.
• It integrates research outcomes and information technology into patient care.
• EBM promotes a bottom-up approach starting with the individual patient.

Purpose of the Study:

• To critically evaluate the assumptions and limitations of EBM.
• To explore the potential risks of EBM becoming an ideology.
• To highlight the importance of considering values in clinical practice.

Main Methods:

• Philosophical analysis of EBM's epistemology.
• Comparison of EBM with value-based medicine (VBM).
• Discussion of EBM's applicability in psychiatry.

Main Results:

• EBM is not value-free and prioritizes quantitative, biomedical approaches over qualitative, humanistic ones.
• EBM may neglect ecological validity, effectiveness, and generalization of research.
• Psychiatry is particularly sensitive to EBM's limitations due to context and values.

Conclusions:

• EBM is a valuable tool when used critically, acknowledging its limitations and philosophical underpinnings.
• Supplementing EBM with value-based medicine (VBM) is crucial for incorporating patient values.
• VBM aids in articulating and weighing the values pertinent to patient care.