Few BJGP readers will disagree with Professor Reeve that ‘[w]e need whole-person, generalist medicine’.1 But I feel that Reeve uses an overly narrow conception of evidence-based medicine (EBM) to justify throwing the baby out with the bathwater. By omitting to reference the growing literature that critiques EBM, this article sets up a straw man, ignoring the well-established move to focus on evidence-based practice. This move challenges the old ‘knowledge pipeline’ model, in which clinicians simply received ‘proven facts’ and used them, and patients relied on clinicians to hand over these facts. Instead, we need to understand the way both clinicians and patients construct knowledge and use it in making decisions together.
I agree with Reeve that this understanding requires a more nuanced model than the version of EBM she portrays. But rather than replacing this old (and increasingly discredited) model with a new one that emphasises the distinction between ‘specialist’ and ‘generalist’ practice, I suggest it will be more helpful to build on Greenhalgh et al’s call for a new ‘real EBM’,2 highlighting the central challenge that all clinicians face: how to use probabilistic information about a population to shape decisions about one individual. Like generalists, specialists should use this information within a holistic, person-centred approach that requires wisdom as well as ‘science’, although we all struggle to achieve this. As a GP, I cannot achieve it in 10 minutes, however much I ‘re-prioritise’. Before trying to devise a way to evaluate my ‘capacity to deliver person-centred care’, why not fund me to offer patients a bit more time and continuity, and then check that I am providing it?
- © British Journal of General Practice 2018