Balancing Evidence, Expertise and Empathy in Clinical Decision-Making
Dr Dean Watson PhD Musculoskeletal Physiotherapist
International Educationalist Watson Headache® Institute; Adjunct Senior Lecturer UniSA; Educating in and Identifying Cervical Afferents in Cervicogenic and Primary Headache; Clinical Consultant Watson Headache® Clinic
Watson and his colleague are enjoying their monthly dinner meetings with the mandatory glass of 2012 Albert Bichot Côte de Nuits Villages Burgundy.
“I have just come back from a conference in which there was a presentation discussing clinical decision-making. You know, the whole Evidence-Based Practice (EBP) versus Evidence-Informed Practice (EIP) debate. What’s your take on it?”
The Rigidity of Evidence-Based Practice
“Ah, the classic EBP versus EIP discussion! It’s an important one. I think both have their merits, but I lean more towards EIP. It feels more… human, if that makes sense,“ explains Watson.
Watson's colleague, sensing a contradictory response, sips on the burgundy. “That’s interesting. The presenter advocated for EBP – relying on high-quality research like randomised controlled trials and meta-analyses, but in the subsequent question time, there were a number of comments that the ‘gold standard’ evidence doesn’t quite fit individual patients – reality.”
The Flexibility of Evidence-Informed Practice
“Exactly!’ exclaims Watson. “That’s where EIP shines. It’s not that EIP disregards research evidence—it values it. But it also considers other critical factors, like the patient’s values, preferences, and the real-world context we’re working in.”
“So, you’re saying EIP is more flexible?”
“Absolutely. EBP can be rigid, often applying standardised guidelines without much room for adaptation. EIP, on the other hand, integrates clinical expertise, patient input, and even practical constraints like healthcare resources or cultural factors. It’s a more holistic approach,” explains Watson.
“That makes sense, audience members related cases where the ‘best available evidence’ didn’t account for a patient’s unique circumstances, like their financial limitations or personal beliefs about treatment,” recalls Watson’s colleague.
“Exactly!” confirms Watson. “EIP acknowledges that not all clinical situations have strong research evidence to guide them. It empowers us as clinicians to use our judgment and experience to fill those gaps.”
Is EIP Less Scientific?
Watson’s colleague reflects. “But doesn’t that make EIP less scientific? I mean, if we’re not strictly following the evidence, aren’t we risking less effective care?”
“Not at all. EIP isn’t about ignoring evidence – it’s about contextualising it. Think of it as a balance. You’re still using the best available research, but you’re also considering the patient’s unique needs and the practical realities of your setting. It’s evidence plus expertise and empathy,” emphasises Watson.
“I like that: evidence plus expertise and empathy. It sounds more patient-centred,” Watson’s colleague acknowledges, sipping more burgundy.
The Patient-Centred Advantage of EIP
“It is. And that’s the key difference. EBP often prioritises research over everything else, while EIP puts the patient at the centre of the decision-making process,” explains Watson. It’s about tailoring care to the individual, not just following a one-size-fits-all guideline.”
“So, in a way, EIP is more adaptable to the complexities of real-world healthcare. That’s a powerful perspective. Practicing more in line with EIP, adapting treatments to what’s best for the patient, even if it means stepping outside of rigid guidelines.”
“Exactly. It’s particularly valuable in diverse or resource-limited settings, where strict adherence to research findings might not be feasible or appropriate. And let’s not forget – it respects the patient’s voice in their own care. EIP is gaining traction because it acknowledges the complexity of healthcare. It’s not about replacing EBP but enhancing it by making it more adaptable and patient-centric,” reinforces Watson. “At the end of the day, it’s about improving outcomes while respecting the individuality of each patient. And that’s what makes EIP such a valuable approach.”
A Holistic Framework for Modern Healthcare
“So,” begins Watson’s colleague thoughtfully, “EIP offers a more patient-centred, flexible, and context-sensitive approach to clinical decision-making. While it values high-quality research, it also integrates clinical expertise, patient preferences, and real-world constraints, making it a holistic and adaptable framework for healthcare professionals.”
A contented Watson pours another glass of burgundy and reflects on the importance of evolving practices to better serve patients.
Until next time
Dr Dean Watson PhD, Musculoskeletal Physiotherapist
Watson Headache® Institute
Email dean@watsonheadache.com Web www.WatsonHeadache.com
P.S. Your connection and participation are greatly appreciated.
Visit our website to learn more about ‘Cervicogenic Headache and the 'Role of Cervical C1-3 (Afferents) in Primary Headache’.
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4moIf you would like me to continue, I'm happy to oblige.
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4moI would like to add my 3 penny worth to this pertinent discussion that comes down to practical wisdom or to use the translated Greek from Aristotle, Phronesis. Patient care comes down to a set of values or principles. I think that red wine is a red herring if I can be so bold as to use a mixed metaphor. Here is my list. 1. We try an work with Nature and not against her. 2. We do not make it worse for the patient but bolster the endurance of the disease process. See Sir Robert Hutchison 3. The disease process has a psychological component on a different axis. This is a team effort. Ignore this at our peril. 4. We should not exploit the patient's emotional, financial, or social, vulnerability. This points up a host of conflicts of interest on the part of the carer and the misuse of power inequality. 5. The use of anagrams or jargon to bamboozle the conversation between the carer and patient. Put it on an easily understood level of the patient. We are trying to build trust and understanding, and not show our ignorance. 6. We will endeavour to do our best for each unique patient. One size does not fit all. If all we have is a hammer, then the nuts and screws miss out. It behoves us to have multiple skills.
BCCI Zonal Head of Sports Science & Medicine
4moHi. Thanks for the discussion. Does it ( “one size fits all”) perspective apply to all methods of EBP ?! Doesn’t Mixed Methods approach include Qualitative Contextual factors ?! Thanks
Senior Physiotherapist at Physio@439 and Advanced Oral and Maxillofacial Surgery, Adelaide South Australia. APA Sports, Exercise and MSK Physiotherapist. Expertise in the management of TMJ disorders
4moIndeed the ‘art’ of examination, clinical reasoning and care, dear Watson!
Clinical Director of Physiotherapy at Advance Physiotherapy and Sports Injury Centre Clinical Director of Physiotherapy at Dee Why Physiotherapy and Sports Injury Centre
4moSuch pertinent discourse Dear Watson! I must put forth that clinical wisdom is not always a product of schooling and researched evidence, but of the lifelong attempt to acquire it! Only after years of grafting your craft, can we sit contently sipping Burgundy, (or in my case, my powerfully perfumed '98 Coonawarra Cabernet), that we can apply informed understanding. I do hope our young clinicians take heed, apply less speed, and listen to their clients, observe them move, assist to reduce apprehension about pain and see their physiology positively change. Our clinicians must strive to be a therapist who assists the clients performance to improve, through hands on therapy and reassurance, education and a true understanding of how it is to heal and improve through empathetic service.