Evidence-based medicine (EBM) and values-based medicine (VBM) are complementary partner components of clinical decision making. This has been referred to as the 'two-feet principle' . Both at the level of diagnosis and for management of a clinical problem it is important that clinicians can work comfortably and effectively with scientific evidence relevant to patient's problem, and with the values at play which comprise not only the patient's values but also the clinician's values and often those of others such as carers or the healthcare organization . Values can be complex and conflicting , and it is here that the skills of values-based practice are needed if shared decision making is to happen within a shared framework of values. Just as a failure to access the appropriate generalizable scientific evidence can mean that flawed clinical decisions result, so (and perhaps more commonly) a failure to ascertain and work with the values affecting the individual consultation can also result in disaster.
Altamirano-Bustamante and colleagues talk of the axiological complexity of clinical practice which extends beyond the EBM domain of epistemological values related to 'describing, explaining or predicting what takes place within the human body' to the VBM domain of social, political and ethical values acting on 'the bio-psycho-social spheres of a person and relating to his/her dignity' . The pathfinders for EBM were quick to recognize the importance of values in this respect. 'By patient values we mean the unique preferences, concerns and expectations each patient brings to the clinical encounter and which must be integrated (with best research evidence and clinical experience) into clinical decisions if they are to serve the patient' .
There is a universal truism in this research group's acknowledgement that 'The healthcare sector is currently facing a crisis of knowledge, compassion, care, cost and values in general; however, few programs have addressed values among healthcare personnel, and little data exist concerning the effectiveness of such programs'. Values are action guiding [6, 7]. This is the rationale for exploring how a continuing medical education (CME) program impacts on the way in which healthcare workers operate in respect of EBM and VBM. Can we facilitate clinicians to work better with values in conjunction with evidence?
The stakes are high, because I expect that there is another universal truth in Altamirano-Bustamante et al.'s contention that 'patients complain more about the lack of courtesy, warmth, understanding, care, and communication than about the lack of updated attention protocols' . If patients sense that a clinician has worked hard to understand their values and to take account of them, the likelihood of partnership working is greatly increased, and antagonism is less likely. By the same token, the clinician who has understood the values at play is more likely to access the relevant_evidence (for example, what is the point in exploring different psychological treatments for depression if the patient has no belief in any of them and only gives credence to pharmaceutical treatments, or vice versa).