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Reflections on Changes in the Study and Practice of Medicine

This is a reflection on an editorial from the Journal of Science and Healing titled: "Finding a Common Language: Resolving the Town and Gown Tension in Moving Toward Evidence-Informed Practice".

We share our thoughts with you to involve you in the practice of medicine and to bring awareness to changes in how medicine is being practiced in the United States. Read the short article here to understand the discussion and commentary below:

Kligler and Weeks imply that there is certain inevitability within the larger movements of the practice of medicine towards, as they say, "an integrated, interprofessional, team-oriented approach to care". If all healthcare providers aim to provide the highest quality, highest safety, highest efficacy, and most informed medical care, then it is essential that all medical providers ensure a common respect, a common language, and a common assessment of the varied landscape of medicine as it unfolds in the 21st century. The complexity and diversity of medical approaches today are one major motivating reason behind Kligler and Weeks’ presentation of specific solutions towards this common language. They argue that this arrival at greater commonality will, "let us walk together on a shared path for how to expand knowledge of what approaches are most effective with our patients."

From the perspective of Traditional East Asian Medicine and more specifically, acupuncture as a dual treatment and diagnostic modality, the recommended adoption of "mixed methods research" offers a foothold for this ancient and rich approach to medicine to be more widely accepted as a valuable and effective system of treatment and diagnosis. The mixed methods approach, which aims to include more layers of information beyond purely quantitative data by including and valuing qualitative data, offers a more complete appraisal of clinical experience. As Kligler and Weeks acknowledge, "too much is being missed by emphasizing purely quantitative methods." This is especially true for complex medical conditions that are treated with complex medical approaches, as is often found with Traditional East Asian Medicine.

Kligler and Weeks’ second feature of the path towards commonality expands on the intention to incorporate qualitative data by encouraging case reports. By pointing to the apparent proliferation of medical case reports as a potentially massive pool of clinical data, all medical professionals but especially those who approaches are complex, partly intuitive, and multi-modal, are able to contribute their valuable perspectives to the greater expansion of medical knowledge. Of course, as Kligler and Weeks state, the success of this endeavor requires agreed upon standards for reporting, just as there are standards for randomized control trials or statistical reviews. Additionally, it would improve the inclusiveness of these case reports by allowing all forms of providers to offer input to the ever-changing standards of the guidelines.

The final component of Kligler and Weeks’ proposal involves humility in the face of unchanging unknowability inherent in the art and science of medicine. Taking a humble and clear-eyed view of the limits of knowledge and science will ensure not only care and respect for intuition, experience, and individuality of patients, but also pushes clinicians and researchers to never stop seeking greater integrity of knowledge and openness to new ideas.

All of these proposed solutions evolve and elevate the practice of evidence-based medicine while also tempering it with humility and inclusiveness. By opening evidence-based medicine to greater dimensions of information and dynamic approaches to medical practice and research, evidence-based medicine can strengthen the entire practice and knowledge of providers going forward.

References: Kligler, B., & Weeks, J. (2014). Finding a common language: resolving the town and gown tension in moving toward evidence-informed practice. Explore: The Journal of Science and Healing, 10(5), 275-277.

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