Wednesday, June 09, 2010

Fast knowledge versus slow knowledge: the insufficiency of EBM

This is not the only post in which I will draw from Abraham Verghese's lecture to the American Clinical and Climatological Association on what it means to be a doctor. Drawing on David Orr's book The Nature of Design he contrasts two types of knowledge:

He differentiates between the two types of knowledge, saying that, “The aim of slow knowledge is resilience, harmony, and the preservation of long-standing patterns that give our lives aesthetic, spiritual and social meaning.”

Fast knowledge, by contrast, operates with the following (false) presumptions: if it can be measured, it is important, and if it can't, it isn't; more information is better and there is little distinction between information and knowledge; fast knowledge presumes that if we forget old knowledge, it doesn't matter since the new knowledge is better; it presumes that mistakes from new knowledge will be solved by more knowledge and, finally, that the acquisition of knowledge has no duty of responsible use.

Fast knowledge is information accessed instantaneously at the point of care. It is obtained by “evidence hunting” and is often prefaced by “Up to Date says...” It is at the core of the popular notion of EBM. Slow knowledge is many things including basic science leading to a fundamental understanding of disease. Fast knowledge is fleeting. Fundamental understanding of disease stays with you throughout your career. Fast knowledge without slow knowledge is of limited usefulness and may be harmful.

Early in my blogging career I wrote about the pursuit of those two types of knowledge, just in different terms.

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