Post Flexner

Flexner's model persisted in one form or another for about a century. Late in the 20th century however, using rationale to its limits and adding communal experience with the advent of Clinical Epidemiology, from the late 1950s onwards was not enough. In 1985 we saw the birth of EBM, Evidence Based Medicine; the notion that pride of place in a doctor's decision making should come from the products of well designed and constructed clinical trials addressing the situation in hand. Dr Guyatt from Canada has been given credit for leading this move though many others were actively involved. The products of individual trials were however disjointed and cumbersome for daily use. This led to the construction of guidelines addressing a growing range of clinical situations. They themselves, managed manually, had their own problems and, mercifuly, the arrival of the personal computer and all tht followed have resolved any residual issues. Now the physician has a full set of resources to assist individual decision making, succinct, authorative and able to be interpreted not only by doctors but by patients and a wide range of healthcare professionals. The Flexner physician no longer has a monopoly. And next came big Data an AI: which knows all the guidelines and can write new ones. Watch this space.