Reenchanting By Reframing: Empirical Evidence as Wisdom
Joel Pacyna, MA, Biomedical Ethics Coordinator / Research Analyst, Mayo Clinic
Jon Tilburt, M.D., MPH, Mayo Clinic
Contemporary medicine has unprecedented access to empirical data accumulating in a rich literature from a time-tested tradition of research. The contemporary physician is expected to cultivate a functional familiarity with this tradition of evidence and practice medicine according to the best available evidence in his or her specialty. Indeed, evidence-based medicine has been championed as a self-evident marker of quality, and the medical field has assumed that patients can appreciate this professional aspiration. One of the traits of the exemplary physician is her awareness of the very latest evidence for a particular disease or therapy and the ease by which she educates her patient in the science supporting one treatment option over another.
But those who see value in the enchantment of medicine may be concerned about how empirical considerations impact the patient-physician encounter. Does the professional emphasis on evidence have the unwelcome effect of demystifying/disenchanting the very personal patient experience of being ill? Do survival calculators and risk stratification schemes objectify and depersonalize the patient experience? Should the physician not mention that her professional recommendations are grounded in cutting-edge empirical findings? Physicians have assumed that patients want to hear about the latest evidence. Indeed some patients do. Has the physician, however, become enslaved to a contemporary tradition of evidence-grounding that has clouded his vision of the patient in front of him? Has he sacrificed his professional prerogative to envision every patient as a potential outlier with emotional, spiritual, and social needs that confound the hottest new clinical trial data?
Empirical evidence should not be discarded, nor even de-emphasized in patient-physician interaction. Perhaps, however, it needs a new name. By renaming empirical evidence, we can swiftly draw meaningful boundaries around its place and function within the clinical encounter. We can invoke an analogical vocabulary that imbues evidence-conversation with humility, balance, care, and creativity. This paper proposes that empiricism be given a theological name―wisdom. By calling empirical evidence “wisdom,” we assign it an important but circumscribed role. Should we be wise? Yes! Are wisdom principles inviolable maxims? Decidedly not. Wisdom, as portrayed throughout the Christian wisdom literature, acknowledges norms and patterns, it regards human tendencies, it urges us to understand ourselves, our relationships, and our environment, but it gives permission to entertain exceptions, to seek unconventional solutions, and even to appreciate mystery in human existence. Wisdom is accessible, but it requires its practitioners to expend effort in finding it and using it.
Could it be that the unqualified regard for evidence has not made the medical professional a deeper, more perceptive individual, but has instead pressured professionals into reductionist paradigms? Has the famed objectivity of rigorous science flattened the dynamic, enchanted encounter between physician and patient? If so, the answer is not to dispense with evidence or turn from the rigorous traditions and methods of research that inform contemporary practice. The answer may be found in employing the theological concept of wisdom as a way of situating empirical evidence within a rich, fully human, enchanted practice of medicine.
Jon Tilburt, M.D., MPH, Mayo Clinic
Contemporary medicine has unprecedented access to empirical data accumulating in a rich literature from a time-tested tradition of research. The contemporary physician is expected to cultivate a functional familiarity with this tradition of evidence and practice medicine according to the best available evidence in his or her specialty. Indeed, evidence-based medicine has been championed as a self-evident marker of quality, and the medical field has assumed that patients can appreciate this professional aspiration. One of the traits of the exemplary physician is her awareness of the very latest evidence for a particular disease or therapy and the ease by which she educates her patient in the science supporting one treatment option over another.
But those who see value in the enchantment of medicine may be concerned about how empirical considerations impact the patient-physician encounter. Does the professional emphasis on evidence have the unwelcome effect of demystifying/disenchanting the very personal patient experience of being ill? Do survival calculators and risk stratification schemes objectify and depersonalize the patient experience? Should the physician not mention that her professional recommendations are grounded in cutting-edge empirical findings? Physicians have assumed that patients want to hear about the latest evidence. Indeed some patients do. Has the physician, however, become enslaved to a contemporary tradition of evidence-grounding that has clouded his vision of the patient in front of him? Has he sacrificed his professional prerogative to envision every patient as a potential outlier with emotional, spiritual, and social needs that confound the hottest new clinical trial data?
Empirical evidence should not be discarded, nor even de-emphasized in patient-physician interaction. Perhaps, however, it needs a new name. By renaming empirical evidence, we can swiftly draw meaningful boundaries around its place and function within the clinical encounter. We can invoke an analogical vocabulary that imbues evidence-conversation with humility, balance, care, and creativity. This paper proposes that empiricism be given a theological name―wisdom. By calling empirical evidence “wisdom,” we assign it an important but circumscribed role. Should we be wise? Yes! Are wisdom principles inviolable maxims? Decidedly not. Wisdom, as portrayed throughout the Christian wisdom literature, acknowledges norms and patterns, it regards human tendencies, it urges us to understand ourselves, our relationships, and our environment, but it gives permission to entertain exceptions, to seek unconventional solutions, and even to appreciate mystery in human existence. Wisdom is accessible, but it requires its practitioners to expend effort in finding it and using it.
Could it be that the unqualified regard for evidence has not made the medical professional a deeper, more perceptive individual, but has instead pressured professionals into reductionist paradigms? Has the famed objectivity of rigorous science flattened the dynamic, enchanted encounter between physician and patient? If so, the answer is not to dispense with evidence or turn from the rigorous traditions and methods of research that inform contemporary practice. The answer may be found in employing the theological concept of wisdom as a way of situating empirical evidence within a rich, fully human, enchanted practice of medicine.