As the dean of a school of nursing at a state flagship university, I have watched with interest the dynamic relationship and natural tension that exists between universities and state legislatures. One observer described it as a "contest between the former's centrifugal desire for autonomy and the latter's centripetal concern for accountability and regulation of teaching, research, and administration."1(p141) Universities desire the freedom to select personnel, design academic programs and content, and manage resources while states demand accountability from universities in how they manage the public funds they receive and how responsive they are to local and regional societal needs. Though seemingly at odds, autonomy and accountability are both important to creating the best educational system possible. Likewise, medical research and clinical expertise are both crucial to the improvement of patient care through evidence-based medicine. Interestingly, society including scientific bodies and their members are asking for accountability. That is, what is your evidence that this practice is effective?
As the "evidence" in evidence-based medicine, research is a key component of healthcare. In fact, the value of scientific research to improvements in healthcare cannot be overstated. Diseases that once were death sentences have been eradicated and procedures that once seemed impossible are now routine. The development of vaccines, Williams & Wilkins. advancements in treatment procedures, and innovations in medical technologies have saved countless lives. Clearly, research has been and will continue to play a central role in medical care. It is important that healthcare professionals recognize, understand, and apply research to their practice and remember that research informs, but does not replace their clinical expertise.2
Despite the value of research to healthcare, evidence-based medicine has faced some critics. One of the oldest (and unfounded) criticisms of evidence-based medicine is that it stifles "the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice" in favor of "cookbook medicine."2(pp71-72) This is simply not the case. Can you imagine healthcare professionals blindly treating patients by simply adding a cup of one treatment, a dash of therapy, and a bottle of pills without consideration of the patient or the situation? While extreme, this example highlights the critical role healthcare professionals play when evaluating research literature. Good scholarship best improves patient care when it is evaluated and processed through the lens of clinical experience. Healthcare professionals should determine the relevance and applicability of research findings and recommendations in light of their expertise as well as important contextual factors including the patient's age, history, values, traditions, and preferences. Evidence-based medicine can lead to more effective and more patient-centered care.
In the end, the effectiveness of evidence-based medicine in improving patient care requires both medical research and clinical experience. This issue of Family & Community Health, presents articles that explore various evidence-based approaches to improving the health of individuals, families, and communities. The articles also recognize the roles of research and clinician expertise. The authors conducted research across a range of settings and present compelling findings that may be relevant to the programs, healthcare plans, and interventions you are planning or currently providing. I hope you enjoy this issue, and that you can apply the content to your work.
Jeanette Lancaster
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