Editorial
The never-ending and inexhaustible search of wisdom in our professional work as ophthalmologists
La interminable e inagotable búsqueda de la sabiduría en nuestro trabajo asistencial como oftalmólogos
J. Jiménez Benito
, L. Macías Molinero, N. Gajate Paniagua, M.J. López Peña, E. Pérez-Salvador García
Corresponding author
Servicio de Oftalmología, Hospital Universitario de Burgos, Burgos, Spain
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Jiménez Benito, L. Macías Molinero, N. Gajate Paniagua, M.J. López Peña, E. Pérez-Salvador García" "autores" => array:5 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Jiménez Benito" "email" => array:1 [ 0 => "jjimenez@saludcastillayleon.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Macías Molinero" ] 2 => array:2 [ "nombre" => "N." "apellidos" => "Gajate Paniagua" ] 3 => array:2 [ "nombre" => "M.J." "apellidos" => "López Peña" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Pérez-Salvador García" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario de Burgos, Burgos, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La interminable e inagotable búsqueda de la sabiduría en nuestro trabajo asistencial como oftalmólogos" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We live in an exciting historical time in which complexity is regarded as its main characteristic. Our profession is set in this framework, as cannot be otherwise, we participate in contemporary problems. There is a broad agreement in defining our era as the information society.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The Internet and social media have modified access to information as never before in the history of mankind. The vast majority of ophthalmologists, even those working in developing countries, can access scientific information with enormous ease. We all have an enormous amount of information on our computers, from countless books related to our specialty to the possibility of accessing the best ophthalmology journals instantly. It is worth remembering that none of this was the case 40 years ago.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Every technological advance deserves an evaluation and although we consider this access to information a blessing, there are dangers in this excess of information, known as <span class="elsevierStyleItalic">dataism</span>. Although it may seem paradoxical, the indiscriminate accumulation of information or <span class="elsevierStyleItalic">dataism</span> generates, on many occasions, confusion instead of knowledge. We consider it appropriate to comment that mere information is essentially partial, incomplete and fragmentary.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Information with data alone is additive and meaningless; it is only useful if we integrate it into a narrative.</p><p id="par0015" class="elsevierStylePara elsevierViewall">It also seems appropriate to reflect on Evidence-Based Medicine (EBM), whose opinions have become unquestionable in medical practice because its methodology reduces the risk of different types of bias in clinical decision-making, which theoretically improves clinical outcomes in patients. Although EBM is the theoretical basis for our healthcare practice, it is not exempt from criticism, such as its tendency to oversimplify the relationship of measurable variables and to emit others that can affect the results, for example, social factors. Along the same lines, it is criticized for not taking into account the intrinsic gap that exists between the experimental setting and actual clinical practice, nor individuality, by standardising results that can be expected for different individuals. An example of this perspective is the criticism related to the devaluation of experience in medical practice, which would tend to “<span class="elsevierStyleItalic">dehumanize</span>” medicine and physicians, and would omit relevant aspects of the physician-patient relationship. Finally, EBM is criticized for attributing to the scientific community alone the power to know, and thus to decide. In other words, if what is correct can only be obtained from scientific evidence analyzed by means of rules known to scientists and physicians, then it would never be possible for patients to participate in decisions.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The hegemonic paradigm of EBM also forgets the individual experience of the physician in his or her practice. In view of the above, we consider it insufficient to decide solely on the basis of the conclusions of EBM.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Therefore, decision making in our healthcare practice is conditioned by the avalanche of information and the totalizing paradigm of EBM. Both problems are very complex and difficult to manage, so we need help since it is an impossible task to resolve individually.</p><p id="par0030" class="elsevierStylePara elsevierViewall">This assistance can be found in congresses and scientific meetings, whose attendance should not be considered a perk but a professional duty. Article 77.1 of the current Code of Medical Ethics and Deontology of 2022,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> states that “<span class="elsevierStyleItalic">Continuing medical education is a deontological duty, a right and a responsibility of all physicians throughout their professional life</span>”.</p><p id="par0035" class="elsevierStylePara elsevierViewall">At congresses and scientific meetings, generous colleagues do the titanic job of selecting the relevant information that we need to know in our specialty. In addition, we also have the possibility of acquiring <span class="elsevierStyleItalic">informal</span> knowledge, outside EBM, which is present in clinical cases, round tables and fruitful vacuous hallway conversations.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> These three activities that we have described have in common their narrative structure, which is much more enriching than the simple <span class="elsevierStyleItalic">dataism</span> that holds the vacuous pretension of absolute truth. In this editorial we advocate a narrative ophthalmology because we consider it the best option for acquiring the necessary wisdom that will allow us to make better decisions for our patients. It seems appropriate to comment that disease, like our life, has a narrative structure.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The prudent physician will articulate his decision in a particular and timely way, with the indispensable help of the narrative that is adapted to the real situation of the patient and his values, because we know that “<span class="elsevierStyleItalic">prudence deals with the particular and not with the universal</span>” and the narrative attends very well to the particular.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Our greatest professional ambition must be to achieve wisdom, which requires <span class="elsevierStyleItalic">formal</span> (MBE) and <span class="elsevierStyleItalic">informal</span> knowledge, but also incorporates experience and prudence in decision making. We are aware that full wisdom is a never-ending and inexhaustible task, it is a necessary impossibility, but it is exciting to try to achieve it.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La sociedad de la transparencia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H. 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