Theory in practice: why "good medicine" and "scientific medicine" are not necessarily the same thing.
The term "scientific medicine", ubiquitous in medical literature although poorly defined, can be traced to a number of assumptions, three of which are examined in this paper: that medicine is a form of knowledge-driven practice, where the established body of proven medical knowledge determines what doctors do; if what doctors do is either inadequate or ineffective, the chief reason is the absolute or relative lack of adequate knowledge for providing care for patients; evaluating medical practice boils down to comparing it to a set of standards which should be univocally applied to concrete situations. This paper intends to provide at least a tentative assessment of how does this set of assumptions fare in the real world of clinical care. The methodology was based on direct observation of medical consultations and independent evaluation by referees of data from of medical records. The review of the data shows a far more contingent relationship between handbook prescribed procedures and actual medical practice, even though the referees evaluated the reported data mostly with favorable scores. Furthermore, a few problems were observed relating to the inadequacy of the so-called biomedical model in dealing with some of the more prevalent health problems. The authors conclude that, more than any "technical inadequacies", it would seem that this study has underlined the limitations of the biomedical model in responding to the tasks it attributes to itself, an issue that has to be addressed more effectively by medical education, be it in terms of undergraduate or graduate schooling.
Departamento de Planejamento e Administração de Saúde, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, R. Afonso Pena, 141/402, Rio de Janeiro 20270-244 RJ, Brazil. kenneth@uerj.br
Kenneth
K
De Camargo
Claudia Medina
CM
Coeli
D000553:Ambulatory Care / Q000592:standards; D001938:Brazil; D036262:Empirical Research; D019317:Evidence-Based Medicine / Q000193:education; D006801:Humans; D008962:Models, Theoretical; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011320:Primary Health Care / Q000379:methods / Q000592:standards*; D011787:Quality of Health Care