National Keynote

Assist. Prof. Bruno Heleno

Assistant Professor at Nova Medical School Lisbon and General Practitioner at USF das Conchas in Lisbon.

I began working in Lisbon in 2006, transitioning from a trainee to a general practitioner. Between 2011 and 2016, I took a break to explore quaternary prevention research and learn how to teach evidence-based practice in Copenhagen. Currently, influenced by the patients I see in practice, I am interested in research how to improve care for people with multimorbidity. Although less often than I wish, I enjoy teaching practicing clinicians how to use acquire, assess and apply evidence to their practice.

Like many clinicians, I navigate the tension between adhering to patient-centered care and evidence-based principles within a pay-for-performance framework. In this lecture, I will share patient stories to highlight the dual challenges and opportunities in evidence-based general practice. I will argue how we need more evidence-based practice to support patient-centered care, offering tools to resist against commercial and unreasonable managerial pressures.

Evidence-based General Practice and patient-centredness

In this lecture, I will share patient stories to highlight the dual challenges and opportunities in evidence-based general practice. Like many clinicians, I navigate the tension between adhering to patient-centered care and evidence-based principles within a pay-for-performance framework. However, by returning to the original foundations of evidence-based practice—combining high-quality evidence, clinical expertise, and patient preferences—we find a way to bridge this gap. Key components of the patient-centered clinical method, such as 'exploring health, disease, and illness' and 'understanding the whole person,' are instrumental in applying evidence-based practice effectively. Similarly, the 5A's of evidence-based practice—assess, ask, acquire, appraise, and apply—enrich our discussions and aid in 'finding common ground' with our patients.

The challenge intensifies with the increasing interference of vested interests in clinical autonomy. Commercial influences, for instance, significantly sway the production of evidence, affecting which diseases are prioritized and how interventions are evaluated. Moreover, the rise of , structured templates, point-of-care prompts, and pay-for-performance incentives often shifts the focus from patient care to management targets. Nonetheless, evidence-based practice remains a powerful tool against these pressures. It equips us with the critical thinking skills needed to question the relevance and robustness of evidence and to ensure our clinical decisions align with patient needs.

In summary, evidence-based practice serves as a foundation for not only addressing the challenges we face but also advancing healthcare in a way that truly benefits patients. It promotes a critical evaluation of evidence and a commitment to patient-centered care, offering tools to resist against commercial and unreasonable managerial pressures. Notable advances in the last 30 years are a broader sense of what constitutes evidence, how to ensure that the voices of patients shape which evidence is produced, and more transparent methods of translating research findings into clinical recommendations. We still need evidence about better ways of understanding each patient as a whole person, or of finding common ground. These are great opportunities for general practice to be even more evidence-based.