The pendulum of evidence-based-medicine has swung high and far to the left. I don't know if and when it will swing back, but I think it may. And as it does I think psychiatry will become much more of a comfortable field for me to talk about with family and friends at the kitchen table. See, if all my decisions for patients were based purely on the evidence of prior trials, then I would never need faith in my profession. Just look at the data and make a treatment choice based on what option produces the best outcome. But just what if my gut is telling me that patient TR just won't do well with an SSRI and that he needs a benzo right now to calm him down because at the end of the day sleep is his most important medicine and he needs a lot of it in the next week. Evidence cautions against using benzos for patients like TR who have a substance abuse problem. But my gut is telling me in the moment I'm with TR that he needs sleep now! So I make a faith-based decision founded on the basic ethical principle of "do no harm."
I don't want to be boxed in by evidence-based medicine only. I respect it for the safety it ensures. But I also think it shows a lack of courage and faith to practice only EBM. I believe in an all-knowing God. I believe this God loves me and my patient equally. I believe He wants our success. Why could not God give me a feeling in my gut that TR just may need a benzo because if he walks out with only an SSRI he's not going to sleep and he's going to wake up and beat his kids and then feel guilty about it and go get drunk and then feel guilty about it and want to escape the vicious cycle by ending it all. Now faith-based medicine must not be construed as an idea to ignore the evidence. I think evidence and faith together should inform treatment decisions and I hope I can practice in a way that I let my patients know faith has at least a part in my thinking.
Suicide rates have not improved since the nineteenth century. We've improved the mortality and morbidity of many illnesses, including CKD, diabetes, HIV, some cancers, HTN, and CVD, but suicide rates persist. Can faith inform the evidence with our patients? Can this joint information give us a more sure gut feeling that TR abuses substances like benzos and opiates but he really does mean what he says that he is staying with his sober uncle for the next 14 days so he can get some R&R and not spiral out of control. Faith would tell me he's telling the truth. Evidence would tell me the addiction is stronger than even the will to live. So maybe as I reason this out as I type I'm inclined to think the evidence should carry the weight and faith can provide the general direction. Faith, together with Evidence-Based Medicine opens up a world of healthy possibilities.
