Applying Evidence-Based Model in Health and Healthcare - Term Paper Example

The Benefits and Pitfalls of Applying Evidence-Based Model in Health and Healthcare Introduction Like many other disciplines, health and medical practice has had non–empirical connotations relying on very loose entities of knowledge with little or absolutely no scientific evidence on which to justify various practices. In addition, many quakes were able to infiltrate the medical field with little or no training and many motivated to making profit. However, the 21st century saw a turn about or departure from this as a result of the increasing acknowledgement or reliability in scientific knowledge and the dire need to protect the medical integrity while eliminating all quakes. Today, all medical knowledge production is formulated on the Evidence Based Approach, practice in health practice/ intervention relying on systematic empirical research or inquiry based on statistical significance, effectiveness in the treatment of a particular ontological problem say Diarrhea. Evidence Based Approach is based on continuous enquiries or questioning of practices leading to scientific explanation. It also involves careful or meticulous observation, enumeration and analysis. Lastly, it requires reporting, recording or cataloguing the evidence for further reference or systematic retrieval (Peille, 2004). Epistemology and Ontology are two philosophical concepts that are vital in the medical field where ontology revolves around invariants or universal of realities i.e. classes of realities as well as the relationship between them. Ontology according to Oliver et al, (2004) entails the study of into the nature of existence or being of something. According to Oliver and his colleques, Ontology endeavors to ask the question as relates to the reality. In other words, what is the disease or what is the symptom. This has been very fundamental in the creation and priotization of medical knowledge where concerned practitioners need to know what they are dealing with or studying. Oliver and his colleague define epistemology as simply the study of medical knowledge and involve practitioners who came to know about existence of certain diseases in a particular patient. Roex, Ann and Degryse, ( 2007) have simply defined epistemology as basically the cognitive beliefs or understandings individuals have regarding knowledge as well as knowing, being also able to determine how(new) information or knowledge is conceptualized and processed. According to the two scholars, epistemology is based on a fourfold tenet; that of certainty of knowledge which varies from the fact that it can be certain towards the belief, that it can be tentative as well as evolving. It is also based on simplicity where it is just simple and accumulation of interconnected basics or facts. Again, it emphasize on the fact that knowledge is objective, this is to say that it resides outside of oneself, not subjective. Lastly, it relies on the tenets on justification which based either on observation or on authority, or, instead, as a result of inquiry and active processing by the knower. Epistemology/Ontology and its relevance in Creation of Medical Knowledge Epistemological and ontological issues have been demonstrated in the generation of medical knowledge in various ways. The current knowledge production is evidence-based, what Mark Risjord (2006) in His Book entitled Rethinking Concept analysis, calls justification of belief on theory. Knight and Mattish (2006) are of the opinion that medical knowledge engage practitioners in conscious, explicit and well thought-out use of latest and best evidence in making decision say about a subject (patient or a particular disease). For stance, medical evidence is categorized in different classes coming from a reliable (empirical) sources and which have involved randomized or unbiased, controlled trials often considered factual owing to the fact that it realties to different evidence as well as in different sources or studies. This is very vital in medical practice because of the following. First, it allows the re-use of the same information in a broader sense, relevant to clinical practice. Secondly, it give or allows for production of knowledge that has authoritative sense due to the fact that it come from several sources and from several methods so that anybody can be able to lace any abstract epistemological debate into a practical context to arrive at a conclusive epistemological assumption with regard to medical knowledge. Last but not least, one is able to envisage the linkages, connections between epistemological approaches used by investigators. It also allows one to ascertain the worthiness of these methods for construction a particular kind of knowledge. One aspect the theories of knowledge adopted by medical practice is objectivity/positivism, which also forms the basis of EBA. Objective knowledge entails that which is form a competent source and which can be proved beyond reasonable doubts. Objective is the ontological realm of objects and facts which exist independent of minds. It is representative information based on valid facts for instance facts about patients and about professional, their specialties and institutions in which they practice. Objective knowledge is also associated with procedural oriented to describe the best practices in both observation and diagnosis as synthesized in a set of guidelines. Though Pauline (2002) argues that objectivity in medical practice should transcend empirical methods to be able to even detect teleological structures and purposiveness of human nature which then ensures medical practitioners gain objective criteria to judge what is healthy or unhealthy. Epistemological approach to medical knowledge also advocates that some ontological realties/specification of human categories be explicitly addressed in order to achieve an objective approach for instance information about the patient, i.e. a priori knowledge about the patient before any examination is done. After objectivity is achieved, then appropriate health outcomes can be realized. Here outcomes are simply changes in health status of individuals, groups as a consequence of a planned intervention as opposed to that intentionally exposing the patient/subject to the risks. It is particularly based on the argument or principle that every clinical intervention must produce a change in the health status of a patient and the evaluators should be able to measure by use of health indicators. An inquiry in the medical field can demonstrate or illustrate why certain practices in the medical practice lead to poor patient outcome that is instead of a good health, it leads to unhealthy status (e.g. infection). To correct this, the study may suggest specific changes in the medical practice for instance sterilization of instruments if this has been proved to bring improved patient outcomes (reduced number of mortality during medical surgeries). In another instance of relevance to medical field, epistemology beliefs or knowledge usually comes to the surface when particularly triggered by ill-natured problem. In most cases, there is no right or wrong answers. Like wise, this is true with medical practice. According to Roex Ann and Degrey Jan, (2007), medical practices are also associated with ill structured problems and in many occasions, straightforward answers are never available. This is also very relevant in teaching medicine where the presence of ill-structured medical instructional programmes as well as assessment in teaching clinical competence (Elstein 1993). Again, while emphasis’ on the use of evidence Based Approach is paramount, equal attention need to be placed on how such scientific knowledge has to be comprehended or understood as well as integrating the same information with available knowledge applied to individual patients. Scientific knowledge works from the level that it has to be understood from the perspective, in which it was founded and must be applied correctly at all times and in each context (Roex and Degrey, 2007). It then follows that a physician who follows the best practices synthesized in the form of guidelines and who places these guidelines in their original context will tend to apply them relative better to his or her patients. Though Epistemology is very crucial in medical practice, there is also the need to take caution in circumstance where poor information leads to poor epistemology. It is clear from the foregoing paragraphs that epistemology put strong emphasizes on detailed studies and information processing strategies or mechanisms which add to our knowledge or belief. Sometimes this can be compromised, hence poor knowledge regarding an ontological class of reality as exemplified by the fact that any specific or particular application of a design theory may not necessarily lead to a good outcome but a bad one owing to the fact that every design scenario is unique and it is really impossible to replicate exactly. However, a single bad outcome is not valid enough to oppose or reject a given theory or approach. In a nutshell, epistemology and ontology as relates to health care and medical knowledge has given rise to one of the intellectual tool that can be applied in discussion, debates and to positively come to a concrete conclusion, that which is associated with high quality information. This can then be used to fill epistemological gaps, direct epistemological behaviour as well as promoting medical information. Overreliance on this alone however is not advisable because of the inherent weakness and therefore there is the need to integrate it with other approaches in the formulation of medical knowledge. References Elstein AS. (1993) Beyond multiple-choice questions and essays: the need for a new way to assess clinical competence. Acad Med.; 68:244-249. Knight, L.V and Mattick, K(2006) When I first came here, I thought medicine was black and white :Making sense of medical students, ways of knowing social science and medicine 64(4) pp 1084-1096 Mark Risjord (2008) Rethinking Concept analysis-editorial review, Emory University Sep 2008 Draft Oliver Bodenreider, Barry Smith and Anita Burgun (2004) the ontology –epistemology Divide: A case study in Medical Terminology; International conference on formal ontology and information system: Turin, 4-6 Nov 2004 Paulina Taboada, Kateryna Fedoryka Cuddenback and Patricia Donohue (2002) Person, Society and Value: Towards a Personalist Conception of Health White Dordrecht, Boston, and London: Kluwer Academic Publishers, 2002, 259 pp. Peile, E. (2004) Reflections from medical practice: balancing evidence-based practice with practice based evidence. In, G. Thomas and R. Pring (Eds.) Evidence-based Practice in Education. Open University Press. Roex Ann and Degryse Jan (2007) Viewpoint: Introducing the Concept of Epistemological Beliefs into Medical Education: The Hot-Air-Balloon Metaphor Academic Medicine: June 2007 - Volume 82 - Issue 6 - pp 616-620. Read More