Expert vs. Expertise in #evidencebased guideline development

In the past, guidelines were often developed by a panel of experts who sat around tables, discussed their experiences and came to consensus on best clinical practices based on these experiences. It was tempting to rely solely on experts, believing their experience leads them to better conclusions. Their authority can be reassuring, but there’s a tendency for those who have years of experience to generalize greatly from that experience and to fail to see evidence that contradicts that experience. The wisdom of experts may be tried and tested but the evidence is limited to the rather biased experience of those few clinicians. Unfortunately, some things get in the way of a critical and fair appraisal of their observations – things like:

    •    The resilience of the human body to recover from many bacterial, viral, physical and even clinically associated assaults on their bodies. (bloodletting anyone?)

    •    The inability of isolated physicians to fairly test interventions by controlled experimentation. Their single practices are often too small for sufficient cases to study scientifically, so they use individual case series. “Let’s try this and see if it works.” Unfortunately, a trial of one is just that. It is heavily biased by individual variation, chance occurrences, and human resilience.

    •    The human brain, which looks for and finds patterns, even when none exist and is resistant to changing belief in those patterns.

We now have greater opportunity to expand on the limited experiences of one or a few by compiling the collective experiences of clinicians and their patients worldwide. Careful capture of complete data about patients, concurrent other treatments given to those patients, the setting where care was delivered, and other factors can help our evaluation.  Additionally, we can better pool data on diseases and conditions that occur too infrequently in a single clinician’s practice so that we can make meaningful discoveries about care and cure. These larger pools of data, when properly collected can help us better find and interpret patterns of disease and treatment.

It is important to note that this development in our ability to gather data does not mean that an evidence based approach eliminates expertise.

IMPORTANT - FOLLOWING AN EVIDENCE-BASED APPROACH DOES NOT REQUIRE THAT YOU CHOOSE BETWEEN EXPERTISE AND EVIDENCE.  IT’S NOT EITHER/OR. IT IS AND.

An evidence-based approach builds on clinical expertise. Instead of asking experts for answers, it asks them to help. It asks clinical experts to:

    •    Identify important problems to solve and questions to ask

    •    Build on research evidence by sharing the data from their experience

    •    Evaluate and interpret evidence for clinical relevance and importance

An evidence based approach multiplies the contributions of clinical experts, by combining research evidence from the experience and expertise of many clinicians and their patients. Local clinical experts play an important role in understanding the accumulated evidence in the context of your local environment.  To choose an evidence based approach means you can integrate available data from thousands or millions of care interactions with the experience of your available local expertise.  It is AND, not OR.

Evidence-based guidance does not rely solely on expert opinion but integrates clinical expertise.

TheEvidenceDoc 6/15/17