A theoretical overview of how our decision making process may affect practising Evidence based homoeopathy

Evidence based homoeopathy (EBH) is the art of presenting homoeopathy on clinical viable grounds using standard scientific tools. According to some, it seems to outshine the realm of classical homoeopathy, in a way that it comprises of reporting evidences in a scientific but complex manner. Many experienced physicians take it as an application of unnecessary epidemiological jagron and statistical tools, just “to prove” that homoeopathy is clinically efficacious. In fact, it is rather simpler for them to practice, than to write long cases and send them again and again for one or the other journal. It is also apprehended by many, that this practice has the tendency to replace the original homoeopathy, since physicians try to report “reports” with alternation of facts, to label homoeopathy as workable and demonstrable in front of others. We have been practicing EBH since inception of homoeopathy, but not reporting all the time. But on the contrary, EBH is also a key method to present homoeopathy to scientific fraternity, and proving the existence of homoeopathy on clinical visible grounds.
There are some burning questions in front of us –

• Has our decision making power has anything to do with EBH?
• Is it so simple to follow the term EBH or does it take long to follow it?

To understand this phenomenon, we must throw some light on the process of acquiring decision making for clinical practice in homoeopathy, since this is the foundation which influences our mind to follow EBH. Decision making is the first step for clinical practice; the right decision may lead us to a right endpoint (selection of remedy). This, along with other factors like experience, intuition, hard work etc. helps a physician to obtain the scientific evidences.
Decision making:

1. By Anecdote: The process goes by relating to previous events, which has an important place in professional learning. It includes risk-benefit ratio, which advises to base our decision on collective experience of thousands of clinicians. It takes into account the previous experiences of physician, who in turn relate them with other incidences and narrate them to others. The process is of vital importance in medical field, since for many trends and facts we may not have ‘proofs’ or proper written records, but experience of senior physicians. It also goes by means of information from physician’s experience his references from books, older manuscripts, etc. Anecdote, many a times, helps us achieving the right decision e.g. selection of remedies based upon historical grounds or selection of group of remedies on advice of a senior physician (since he had the same problem in his life earlier, in similar cases), but is anecdote the right path to be followed for EBH? Yes surely, only if it complements the process of EBH. It is not wrong to apply the anecdotal powers to prescribe in homoeopathy. For EBH, these anecdotal processes of prescribing should be well sought of, judgmentally applied and critically reviewed. The case, process, application, results and justification thus obtained should be recorded as per scientific norms so that the collective database serves as EBH for future work.

2. By provocation: It is a common process to provoke younger generation by criticism and comments, so that they may perform better under pressure. Provocation can only prove beneficial if it is accompanied by reward at the end. But in majority of the cases, this approach may have devastating outcomes, when the pressure to perform rises with fear of being insulted with limited knowledge and its application. EBH in this case cannot and should not be expected.
3. By referring to printed material(s): It consists of consciously or unconsciously altering decisions based upon published literature, magazines and journals, e.g. if it is printed somewhere that all patients should be prescribed a particular medicine in a particular potency which was proved beneficial in a certain group of patients, majority of readers try to adopt the same, at their level.  It is a common method, which majority of us follows. Usually we use only that portion which is of our interest but do not stress upon statistics, methodology and randomization used to achieve the end point. This type of decision may not always prove beneficial in every case, but it can serve as a pillar for EBH if the methodology is replicable at clinical ground in an easily comprehensible manner. This mode of decision making along with clinical expertise may serve the purpose.
4. By Expert opinion(s): It may be summarized as the process by which opinion is given especially by senior physicians, in public or through journals. This, however, sometimes supported by physician supporting pharmaceuticals, free journals, magazines etc. This aspect should be followed up critically for application of knowledge and comparison with previous events of similar nature. EBH, in this case may be a tedious process. We may encounter several statements made in the past based on ‘Expert opinion’ holding very high or no importance today. This area of decision making should always be tested critically on scientific grounds.
5. Financial aspects: This is one of the most important yet not clearly visible aspects of scientific validation of facts as well as clinical practice. Financial aspects are associated with decision of choosing or rejecting apt intervention in a particular set-up. For e.g. not every clinic/clinician has the facility of taking high quality picture of evidences of skin lesions, or USG of every patient cannot be done at village level because of limited financial status of patient. There is also a lack of set of ethical guidelines or analytical tools, which can be used to match limited resources to unlimited demands. EBH in this case is a challenging job. In presence of cost minimization and ever increasing demands for investigation proofs in EBH, the quality of EBH may suffers a lot! This type of decision making must be surplused with charity aids, motivation, cost minimization and application of apt scientific methods in such set-ups.
6. Formulation of problems: This aspect of decision making works in the background. To challenge a current situation or to present some facts and figures, we must identify the exact problem and formulate justifiable yet new questions. This gives us the insight to achieve solution(s) for it and to present it in an easy manner.

The article has briefly touched upon the sensitive area of our clinical decision making powers and their application for Evidence Based Homoeopathy. We must be very clear in our understanding towards our science, and we must be sensitively sensitized for carrying out genuine work for EBH. Whatever route, school or thought we choose to practice homoeopathy, must be accompanied with use of modern scientific methods and tools. One must be able to convert the vastness of a case to comprehensible scientific statements. It is just like making quality rubrics out of hundreds of observations, symptoms and signs and to analyze them to reach a justifiable handful totality.
EBH is a burning topic, not only because it is concerned with application of complex process to clinical cases, but it is also associated with the pressure with which a physician undergoes to prove our science. The need of hour is to identify the weaker points and to strengthen them with evidences. This is not merely to satisfy the double headed monster engulfing homoeopathy but to motivate our younger generation with scientific blends. This will inspire them to support homoeopathy in a better way in coming years of scientific and molecular struggle.