h2cm and clinical equipoise

The past few weeks reading the Journal of Evaluation in Clinical Practice - I've encountered the concept of equipoise: specifically the clinical form.

The Health Career - Care Domains - Model is all about 'poise'.

The model's care domains provides the perfect workout.

Medicine, health and social care constantly exercises us. We are, whether or not we recognize it, on a balance board. In fact if you consider that image and then factor in the complexity of health care today you realise just how much stuff (technology), how many people (subjects, agents) need to be on that same board. Who does the board belong to though? Well of course it's -

Jo Public's (... and often off-balance, strengths depleted, sick (and tired), relapse prone...)

The April 2010 issue of the above journal is a fascinating read. I noticed today that some of our placement students were not aware of the recent and current position regarding health policy: that is the 'long view' of decades such as: Health of the Nation, the National Service Frameworks, Darzi ... They need to address that and I'm sure they will.

This journal issue prompts me to consider evidence based medicine anew, especially:

• Its history spanning 20 years.
• Its occupying the SCIENCES domain, with its weight threatening to overbalance all (you could say it's a significant singularity).
• The realization that the Emperor is short on clothes.
• Given the above it can mature. Bogdan-Lovis and Holmes-Rovner (2010)

Back to that board: and stepping onto the health care domains - all four of them so spread your feet - you can see instantly (feel that feedback) how EBM, shared decision making and (person) patient-centered care are all related. As Bogdan-Lovis and Holmes-Rovner (2010) highlight:

Equipoise is the heart of the shared decision making movement, and it embodies the problems for which patient decision aids are most often developed to explain the risks and benefits of competing alternatives. p.377.

h2cm is well suited to this task on so many levels.

The past week or two I've also noticed several mentions of the need to nudge people - here and there - both in the media and in Bogdan-Lovis and Holmes-Rovner's paper and references.

More to follow - and as you step-off take care ....

Wilson, K. (2010) Evidence-based medicine. The good the bad and the ugly. A clinician's perspective. Journal of Evaluation in Clinical Practice, 16, 398-400.

Bogdan-Lovis, E., Holmes-Rovner, M. (2010) Prudent evidence-fettered shared decision making. Journal of Evaluation in Clinical Practice, 16, 376-381.

And for the week ahead:

One mind, many minds - ONE PLANET. One need, many needs - ONE PLANET: what price stability?

http://hodges-model.blogspot.com/2009/02/one-mind-many-minds-one-planet-one-need.html