No evidence without context. About the illusion of evidence‐based practice in healthcare

Evidence-based practice as the basis for good healthcare is an illusion. The Council for Public Health and Society (Raad voor Volksgezondheid en Samenleving, RVS) pleads the case in a recommendation issued today called “No evidence without context: About the illusion of evidence-based practice in healthcare” for placing the context within which care is given at the centre of the practice, policy and financing of healthcare.

The emphasis in healthcare has shifted to external accountability, transparency, standardisation and controls. Much of what is valuable in the personal relationship between client and healthcare provider is not encapsulated in the existing research methods and indicators. By making this recommendation, the RVS wants to initiate a dialogue from a different perspective about new foundation for good healthcare.
 Jan Kremer, an RVS council member, says, “Good healthcare is above all a question of heart and soul, not merely intellect. It’s about what we think is right to do in the vulnerable phases of people’s lives. And that’s not the same for everyone. Unambiguous scientific evidence does not do justice properly to this moral and personal side of good healthcare. We need to keep talking to each other about what constitutes good healthcare, with the human context as a key input.”

Focusing on the context has consequences at three levels: nationwide, locally and in the consulting room. For all those levels, RVS wants to get away from relying on uniform evidence and move towards encouraging learning and improving together, in the context where the healthcare is provided. Medical decision-making in practice is based on linking different sources of knowledge together, such as stories, experiences, local data and (still) evidence. That way of working goes hand in hand with uncertainty and ongoing learning and improvements. This demands greater trust from both the supervisory bodies and the funding of healthcare in the judgements that professionals and patients make together, and rather less on strict observance of restrictive guidelines.