from Part III - Guidelines on the Pharmacotherapy of Tics
Published online by Cambridge University Press: 16 August 2020
Over the last few decades, evidence-based medicine has established itself as a new paradigm for teaching and practising clinical medicine. Double-blind randomized controlled trials and high-quality observational studies have gradually replaced tradition, anecdote, and theoretical reasoning from basic sciences as sources of evidence to complement clinical expertise in order to fulfil patients’ needs. The development of disease-specific guidelines has arguably contributed to the process of making clinical practice more scientific and empirically grounded, resulting in safer, more consistent and more cost effective care. However the evidence-based paradigm has received criticism based on the argument that the emphasis on experimental evidence could devalue basic sciences and the tacit knowledge that accumulates with clinical experience. Moreover, it has been argued that the evidence-based movement arose primarily from a desire to standardize care, rather than individualizing it. Practising medicine according to the standards set out by guidelines could be seen as antithetical to practising according to clinical judgement: standardization can only identify best practices for an ‘average’ patient under ‘average’ conditions, whereas clinical judgement is by definition personal and seeks to decide what is best for a ‘specific’ patient at a ‘specific’ time.
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