http://www.biomedcentral.com/content/pdf/s12916-015-0437-x.pdf
(Open access)
(Open access)
Six ‘biases’ against patients and carers in evidence-based medicine
Trisha Greenhalgh*, Rosamund Snow, Sara Ryan, Sian Rees and Helen Salisbury
Author Affiliations
- *Corresponding author: Trisha Greenhalgh trish.greenhalgh@phc.ox.ac.uk
Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
BMC Medicine 2015, 13:200 doi:10.1186/s12916-015-0437-x
The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1741-7015/13/200
Received: 12 May 2015
Accepted: 24 July 2015
Published: 1 September 2015
© 2015 Greenhalgh et al.
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Abstract
Background
Evidence-based medicine (EBM) is maturing from its early focus on epidemiology to embrace a wider range of disciplines and methodologies. At the heart of EBM is the patient, whose informed choices have long been recognised as paramount. However, good evidence-based care is more than choices.
Discussion
We discuss six potential ‘biases’ in EBM that may inadvertently devalue the patient and carer agenda: limited patient input to research design, low status given to experience in the hierarchy of evidence, a tendency to conflate patient-centred consulting with use of decision tools; insufficient attention to power imbalances that suppress the patient’s voice, over-emphasis on the clinical consultation, and focus on people who seek and obtain care (rather than the hidden denominator of those that do not seek or cannot access care).
Summary
To reduce these ‘biases’, EBM should embrace patient involvement in research, make more systematic use of individual (‘personally significant’) evidence, take a more interdisciplinary and humanistic view of consultations, address unequal power dynamics in healthcare encounters, support patient communities, and address the inverse care law.