The myopia of 'Evidence Based Practice'

I have had a few conversations with people on blogs and on twitter but i still don't get the somewhat narrow approach to 'evidence based practice' that is prevalent. I attended a presentation recently where the presenter outlined all of the evidence that she had ruled out leaving herself with a myopic pile of RCTs. Why do we, and i refer to many disciplines of health professional here, subscribe to the myth that is the 'positivist', 'hierarchy of evidence'. This narrow approach that disregards the grey literature and, indeed, most qualitative research, misses out on the richness of data that can be synthesised to answer many clinical and other questions. why is the nature of what is construed as 'knowledge' so so rigid and narrow? Why are so many wedded to the notion that the hierarchy of evidence creates ontological certainty when, of course - it can't - it just creates another expression of probability?
Of course there are many critiques of EBM - it is valuable yes, but is not the be all and end all - the nature of knowledge is complex, dynamic and exciting - let's embrace this in our practice and understanding. and perhaps, what is even more important, lets' encourage our students and mentees to question the hierarchy and positivist approach and embrace divsrsity in the nature of knowledge.


  1. I understand your sentiment completely! I was saddened to hear my OT students had been told by a Physiology Prof that RCTs were the "gold standard" and I questioned them... "The gold standard for what?" we had a lengthy discussion about the times and places that it would be unethical to attempt an RCT, let alone difficult to get funding, time, support etc etc... so the students thought again about so called "gold standards" and thought about practice-based research, sharing new knowledge in a timely and collaborative way and hopefully actually thought they might have something to offer without an RCT! Good questions are the foundation for good EBP in my mind :-)
    Cheers, Anita.

  2. Absolutely. Good questions that are contextually appropriate and considering different epistemologyies - the hierarchy of evidence/knowledge is but one and so much is lost from the rich potential of an open mind. Acknowledging that rigour and validity come in different forms as discussed particularly in the qualitative research literature (Denzin, Morse etc).


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