Evidence-based medicine vs. the power of the anecdote

Personal experience is how we learn things, so individual anecdotes have enduring power  in how we humans understand and explain things. I suppose we should not be surprised by this. After all, an anecdote is a story, and humans are story-tellers by nature.

These days physicians are exhorted to use only the hardest of hard evidence to make decisions, to use only what is called evidence-based medicine. Some think we should be compelled to do this by means of things such as practice guidelines. I have no objection to this in principle (who would?), but there is a problem with it: for much of what we do, even in the high-tech environment of the PICU, there are little (or even no) evidence-based guidelines to use. We do what we think is best based upon what we have been taught and what has worked in the past. And we use anecdotes — stories we have heard or things we have seen.

Rafael Campo, the award-winning physician and poet, has some interesting things to say here about the power of the anecdote, the human story. At the end of one of Dr. Campo’s lectures, a distinguished physician posed this question — or challenge, really:

“Do you really expect physicians to accept the notion that what any ignorant patient tells us about his disease should carry a weight equal to what our years of training and expertise reveals to us about complex pathophysiology?” Then came what was clearly meant to be his coup de grace, delivered in an almost derisive tone. “Really, sir, do you have anything more than the anecdotal evidence you shared to support your thesis?”

For myself, I continue to see medicine as a complicated mish-mask of science, near-science, intuition, guesswork, and blind luck. Although we should always use the best science we can, somewhere in the mix there is a place for the anecdote, the story. I wouldn’t want it to be any other way.