The Science of Medicine - SOM®

The Science of Medicine - SOM®
by BradMD
(Brad Hennenfent, MD)

What is the science of medicine?

The science of medicine is the first step of evidence-based medicine. So, What is evidence-based medicine?

Evidence-based medicine consists of three things.

1. What the science says
2. What the physician knows
3. What the patient wants

I have summarized my simple definition of evidence-based medicine partly from a complicated 2008 medical article, which defines evidence-based medicine as:

"Evidence based medicine (EBM) is the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. EBM integrates clinical experience and patient values with the best available research information."
SOURCE: Izet Masic, Milan Miokovic, and Belma Muhamedagic. Evidence Based Medicine – New Approaches and Challenges. Acta Inform Med. 2008; 16(4): 219–225. Accessed 11-28-2018.

You can see that this "Masic, Miokovic, and Muhamedagic" definition combines three things:

1. best evidence
2. clinical experience
3. patient values and preferences

What makes it confusing is that there are three terms:

1. Science-based medicine
2. Evidence-based medicine
3. Evidence-based practice

These terms are defined differently in different places and during different times in medical history. Most people would probably be surprised at the range of definitions and controversies surrounding evidence-based medicine.

Gordan Guyatt, MD, from McMaster University is credited with inventing the term "evidence-based medicine" and publishing it in 1991.
SOURCE: Guyatt GH. Evidence-Based Medicine [editorial]. ACP Journal Club 1991:A-16. (Annals of Internal Medicine; vol. 114, suppl. 2).

One website says: "Dr. Gordon Guyatt from McMaster University, who coined the term 'evidence-based medicine'...."
SOURCE: UpToDate. Accessed 11-28-2018.

The McMaster University website, in an article written by Gordon Guyatt, MD, says:

"What are the defining principles of EBM?
"EBM describes a set of practices to help solve clinical problems
"Essentially, EBM encourages physicians to use the best available evidence to inform clinical decisions
"Evidence takes the form of published literature, or unpublished personal observations"

SOURCE: Gordon Guyatt. Evidence-based Medicine. McMaster University Website. Accessed 11-28-2018.

Note, that in the original Gordon Guyatt - McMaster University definition of evidence-based medicine, the patient was left out of the decision-making process. Gordon Guyatt, and McMaster University defined evidence-based medicine as only two things:

1. Best available evidence
2. Unpublished personal overservations

The patient was left out of EBM in the beginning, and medicine remained paternalistic. The doctor told you what was best, based on what the doctor thought was the best evidence and based upon the doctor's unpublished personal observations.

Today, because of the transparency of information brought about by the Internet, many patients, patient groups, doctors, and nurses are trying to end paternalistic medicine and move medicine, the science of medicine, evidence-based medicine, or evidence-based practice, into a process of shared decision-making so that the patient is never left behind. In medical ethics, this is part of the principle of "patient autonomy."