Care and research concepts should be revised to practice outcome-based medical care

Abstract

Objectives: A central question of medical care ethics is what is "good medical practice?" We will defend the argument that medical ethics must include care research not only to find out what "good" practice will turn out to be in the future once results are available but also to guide practice in the meantime, when no one knows what to do, optimizing patient outcomes in real time.

Study design and setting: This work is a summary of our reflections on the barriers to progress we have encountered after many years of implementing small randomized controlled trials in our clinical field, but which are certainly present in other fields as well.

Results: We review nine conceptions regarding care and research that need to be revised if we are to practice outcome-based medical care.

Conclusions: These revisions lead to a reconstruction of the care-research separation, where care research is reintegrated into care using trials specifically designed to offer optimal care in spite of uncertainty, in the best medical interest of participating patients.

Keywords: Care trials; Comparative effectiveness; Learning health care system; Randomized controlled trials; Research ethics; Research-care dichotomy.