- Education Health Care Knowledge

Evidence Based Practice

Reality is vast.  Yet, action requires knowledge.  So over time, we have created systems of practice and knowledge by which we can understanding reality and effectively do something.  Clearly, then, the way in which minds are training within systems, and the relationship between knowledge and practice, is crucial.


Medicine is one such system of practice and knowledge that has an associated educational process.  There have been many criticisms leveled against medical education, to varying degrees of validity.  However, arguably the most damaging outcome of the current medical education system is a certain biased way of thinking: that practices are determined by theoretical pathophysiological reasoning more so than adopted from evidence garnered from the field.


There is a certain receptor found in heart cells, a beta-receptor, that increases the speed and strength of the heart’s pump.  “Beta-blockers”, they are called, a class of medicine that blocks the workings of this receptor, was frequently used, logically so, for patients with high blood pressure.  And when a patient has heart failure – ie, the speed and strength of the heart’s pump is no longer adequate enough – it seemed, from knowledge gained through pathophysiological reasoning, the worst possible practice to administer a beta-blocker.  Yet, over the last few decades, the system of medicine has learned, through evidence, that the opposite is true: beta-blockers are first-line medicines for heart failure and generally fourth-line at best for high blood pressure.  And I’m not quite sure why (probably because I didn’t pay enough attention in medical school).  But, ironically, that might be a good thing – reasoning through the basic science of the cardiac system leads to an ineffective practice.  Knowledge of experiential evidence leads to an effective practice.


Now, this doesn’t mean that theoretical knowledge isn’t important; in fact, conceptual understanding contributes to an agility of mind that can use creativity to solve difficult problems and explore reality to contribute to systems of knowledge.  Yet the theoretical must be moderated by the practical.  If too much emphasis is given on theoretical reasoning (as in the case with the training of physicians in medical education), it results in arrogance, extreme individualism, lack of standardization, and stagnation.  When there is too much emphasis on training in technique without conceptual understanding (as in the case with the vast majority of educational programs), the result is passivity, blind obedience to protocol, lack of creativity, and, again, stagnation.  It seems the only way to progress forward is to understand how to move between conceptual and practical in a healthy way.


Analogous to scientific systems of knowledge and practice (like medicine), there is religion, a system that seeks to gain knowledge about the Word of God and spiritual dynamics in order to put it into practice into individual and social progress.  Again, the same insights can apply.  It’s true that the Revelation has transformative effects on both individual hearts and society as a whole.  Yet the practice – ie, the interaction with the Word of God – is something that cannot be reasoned through by simply reading the Writings and coming to conclusions; for 10 people will have 10 interpretations, just like 10 medical students will have 10 preferences of which blood pressure med to start with.  And the question is not “does blood pressure medicine work?”, just like the question is never “does interaction with the Word of God lead to transformation?”; obviously the answer to both is “yes”.  Rather, a good scientist will put the question of “what kind of interaction with the Word of God” to the field of experience, in the same way that a good physician will survey two decades of actual patient experiences to try to learn “what kind of blood pressure medicine?”.


Enter the Ruhi Institute.  Of the many, many, curricula that were developed over the years, each fostering a certain kind of interaction with the Word of God, it proved through experience to be the most effective.  And probably because it wasn’t the brainchild of a group of people who worked very hard and very sincerely to come up with a set of courses based on their theoretical understanding; rather it emerged from decades of practical experience trying to learn about effective methods.  Its system of knowledge and practice is based on evidence.  So maybe we don’t exactly know why it works, but we know it does.  And that a practice works is great foundation place to start to gain knowledge, to learn more about reality, answering the “why” questions.


At the end of the day, reality is vast.  It is presumptuous to think we can reason through it and then determine best actions.  Rather, let proven practice guide our quest for knowledge.  We know beta-blockers are effective treatments for heart failure – given this, what, now, can we learn about the relationship between myocardial contractility and neurocardiac receptor feedback?  We know that the Ruhi Institute’s sequence of courses effectively fosters individual and collective transformation – given this, what, now, can we learn about the elements of interaction with the Word of God and the spiritual dynamics of the environment within which it takes place?


As we build a conceptual understanding from effective and rich practices and experiences at the grassroots, we learn to exercise moderation and avoid extremes.  We avoid arrogance and passivity and instead become active protagonists with a humble posture of learning; we avoid blind obedience and extreme individualism and instead become empowered through cooperative action towards collective betterment; we purposely exert creativity within fruitful areas of inquiry; and, as is the pattern since humanity’s birth, learning propels progress.

Expansion & Consolidation Junior Youth Empowerment Program

What was the patient’s pulse?

RESIDENT: Patient is a 62y M who presented with shortness of breath, cough, and fever, diagnosed with pneumonia by chest X-ray in the emergency room, and is now, hospital day two, in the intensive care unit on broad-spectrum IV antibiotics for sepsis secondary to pneumonia.  Earlier this morning, patient is dong well; overnight, no events.  Vital signs are stable.  On physical exam…

ATTENDING: What were the vital signs?



In clinical medicine, there are a set of vital signs, including temperature, pulse, blood pressure, and respiratory rate, that help a clinician to assess the patient.  If the respiratory rate is high, perhaps the asthma exacerbation isn’t getting better; if the pulse is low, perhaps there is an arrhythmia.


The problem with these measurements are that they are a point in time, a static reading of otherwise dynamic process.  In the above scenario, unless the vital signs were abnormal, there isn’t much utility in saying that “at 7:38am this morning, for one second, the patient’s pulse was 83.”  It could have changed after walking away.


The purpose of measurement is to more and more precisely describe reality.  We are still affected by the enlightenment’s static and reductionist worldview; with the accompanied coarseness of mind came a loss of understanding the complexity of existence.  With a mechanistic vision of the universe, perceiving the subtleties of change gradually faded from scientific inquiry – reality was forced into boxes and integers and human definitions.  Instead of seeing change in all things, the idea of staticism was introduced.  Yet, reality begs to differ.  When a patient’s pulse is “unchanged” at 75 from one minute to another, it is not a default static state; rather, an extremely complex set of physiobiochemicalneuroendocrine interactions are working to maintain the pulse at that rate.  The only thing not changing is the number on the monitor and the frequency of the beeping sound; only our measurement is the same number from second to second.  But all things change – it is a law of reality.  Movement is an essence of existence.  And even stillness is not lack of change, but rather a state of dynamic equilibrium.


Clearly, in order to describe reality more precisely, we need more profound conceptions of measurement, and not simply more measures (as is the response of medicine, for example).  Throughout the history of medicine, blood pressure has been one attempt at this.  Hundreds of years ago, pressure was measured as a single number – the pulse pressure.  This was originally done with inserting a tube into a cut artery; as this proved too dangerous, non-invasive methods were used.  Yet, it was still a single number, “pressure”.  It was only just around 100 years ago that the concept of systolic and diastolic pressure was introduced, the one we currently use.  The value of the maximum and minimum pressure exerted on the artery walls at any given heart beat is vastly more informative that a single number representing arterial pressure.   Why is it more informative?  Because it’s one step closer towards a more adequate reading of reality.


The measurement of blood pressure as a spectrum is a step towards reflecting the underlying truth of reality that all things are on a continuum.  Perhaps pulse can be reported as “between 65 and 72 overnight” or “between 45 and 110, with an average of 82 overnight” (which are two different clinical pictures).


The work of the Bahá’ís and their friends in community-building at the grassroots is based upon a progressively more precise reading of reality.  And reality is a dynamic continuum.  The mode of functioning, at the same time, of this community-building work is systematic – which involves quantitative (and qualitative) measurement.  The Baha’i community has been learning about placing its descriptions of reality on a ever-more-rich continuum.  This helps avoid two pitfalls – both manifestations of the same underlying tendency to reduce reality – which have plagued society for years: collapsing all individuals into one middle group (such as in the case with school systems) or collapsing all individuals into one of two bi-polar groups (such as in the case with political systems).  The reality, instead, is that there is a continuum.


Take the example of a group of junior youth engaged with the junior youth spiritual empowerment programme.  One can describe them by saying, “The group has around 12 junior youth, and the group has completed one of the texts so far, and 7 of them were at the first service project”.  One can also – more precisely – describe the group by saying: “The group has 22 junior youth that are associated with the group – 6 form the core and have completed every lesson, 9 come sometimes and have done more than half the lessons, and another 7 have come at least once or twice and the animator and junior youth are in contact with them.  7 were at the first service project, yet another 4 were at the planning meeting, and 2 lent supplies; a participation total of 13.”  What a more befitting way to describe the reality!  These activities are living and moving and changing – they are dynamic.  The pulse pressure is not a static 12, but a dynamic 22 over 6…



As we sharpen our perception, we will learn to recognize and measure social and spiritual dynamism in both movement and stillness in order to build vibrant community life.