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Mason Institute Investigates Episode 5: Clinical decision making: Evidence based, or Values based?

Welcome back for another episode of the Mason Institute Investigates podcast. This episode’s guest is Professor Jonathan Michaels (Twitter: @JonM_ScHARR), Honorary Professor of Clinical Decision Science at the School of Health and Related Research at the University of Sheffield. In this episode, Professor Michaels talks about evidence-based decision making in medicine.

Professor Michaels emphasises that evidence-based guidance is underpinned by assumptions, value judgements, preferences and potential biases embedded within the evidence and process for decision-making.

“…sometimes there’s a concept that evidence-based health care is a sort of a scientific process where lots of experts get together and they review all the evidence, and out of that comes the decisions about what we should be doing and if you look at NICE guidance, often the guidelines may have many thousands of pages of supporting documentation that’s often quite technical. But at the end of the day, what those guidelines require is that you make value judgments, and that’s often obscured by the very technical language. So, it looks like it’s an expert decision about what we should be doing, whereas in fact hidden in there, there’s often a lot of value judgements.”

Professor Michaels also addresses potential imbalances and injustices that are inherent in current appraisal processes that include stakeholders for technology or diseases under consideration but does not include any representation or advocacy for unidentified people whose services may be displaced by increased demands on resources in other areas.

“So, there may be a lot of biases in the evidence that’s actually available to people when they make these decisions, and then the actual process that’s gone through in order to make the decision involves the stakeholders that are involved in that particular technology. It involves the industry. Often there are patient representatives or patient representative groups. The clinicians who are interested in that particular technology and all those people, are the people that are in the room when the decision is made, but what’s not talked about is the people who are not in the room. The people whose technologies may be displaced because the health service has a limited budget.”

As the NHS struggles to provide the expected standard of care amidst a post-pandemic financial crisis with rising inflation, Professor Michael’s discussion provides additional insight into the intersection of clinical decision-making with healthcare policy and expenditure.

Listen to the podcast episode on Media Hopper.

View the accompanying episode transcript (PDF)

Check out the channel of Mason Institute Investigates for other episodes.

For more information, please see the below links to further resources. Happy listening!

Written by Leyla Noury (Twitter: @dheggacad)

Links and further resources:

J A Michaels, Value assessment frameworks: who is valuing the care in healthcare? 

J A Michaels, Paying more for highly specialised technologies: equity or profligacy? BMJ Blogs, 3 June 2021.

J A Michaels, Potential for epistemic injustice in evidence-based healthcare policy and guidance. J

J A Michaels, Valuing the care in healthcare: priorities and trade-offsBMJ Blogs, 16 March 2021

J A Michaels, NICE’s wrong turns: opportunity costs and missed opportunities. BMJ Blogs, 30 November 2020

J A Michaels, COVID-19: value-based policy making. BMJ Blogs, 8 July 2020

J A Michaels, Don’t blame the science. BMJ Blogs, 4 June 2020.

J A Michaels, Evidence-based injustices. BMJ Blogs, 29 May 2020.

J A Michaels, Are NICE processes fit for the evaluation of new interventional procedures? British Journal of Surgery, Volume 106, Issue 13, November 2019

National Institute for Health and Care Excellence, NICE Listens


‘Mason Institute Investigates’ is produced and edited by the Mason Institute and made with funding from the Edinburgh Law School.

The intro song is ‘Secret to Success’ by Scott Holmes Music

The outro song is ‘Inspirational Outlook’ by Scott Holmes Music

Both are available under Attribution-NonCommercial 4.0 International Creative Commons Licence from Free Music Archive

Image by guvo59 from Pixabay

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