An Evidence-Based Hypothesis: Doctors Do Not Make Decisions Randomly but Based on Individual Patient’s Risk Profiles

Abstract

According to Sir Archibald Cochrane systematic errors can be avoided in clinical studies if the three dimensions of health care are confirmed: (a) the objective principle of action (the Proof of Principle, PoP) (b) the objective suitability in everyday care (the Real-World Effectiveness, RWE), and (c) the subjectively perceived value (Value). The strategy for confirming these three dimensions is suggested. The method for proving the suitability of health services in everyday care (RWE) is described in six chapters: 1. The basis for the evaluation of health services. 2. The "terminology conflict" used to describe the "natural chaos in everyday care". 3. The proposed solution to prove suitability for everyday use. 4. The method for detecting everyday effects of health care. 5. The importance of emotionally perceived information. 6. Goals that can only be achieved in Pragmatic, not Randomized Trials.If the hypothesis that physicians base their decisions on the risk profile of the individual patient is accepted, medicine can take a significant step forward. This step brings about a change of perspectives. Decisions for (non-experimental) day-to-day care are no longer derived from experiments but from (pragmatic) controlled observations of everyday care.