what
does evidence-based medicine mean?
Evidence-based
Medicine (EBM) is not something new, in fact it has been with
us for a very long time. The exact moment it came to be is not
clear. Some say it was in post-revolutionary Paris or maybe
even in BC China. Some latecomers say it is 1992. All of
this is not that important, what is most important is that it is
here, and here to stay! It is also not impossible
to practice either. EBM is not "cook-book" medicine,
and it is not something we pull out of a hat like a magician
either!
It
is the conscientious, explicit and judicious use of current
best evidence in making decisions about the care of individual
patients. The practice of EBM is the integration of individual
clinical expertise and the best available evidence gained
from systematic research. The end result of all this is
happy and healthy patients.
A
good doctor will make use of both his\her clinical expertise
as well as the best available external evidence,
neither of these two aspects alone is enough.
External
evidence can inform, but it can never replace individual clinical
expertise. The individual clinician’s expertise is
that which decides whether or not the evidence he or she has
gathered is applicable to a particular patient, and if
so, how it should be integrated into the appropriate clinical decision.
EBM builds on, but can never replace clinical skills,
clinical judgement and clinical experience (Sackett et
al 1997)
Why
the need to practice EBM?
The
following reasons may just change your mind about the way you
are currently practicing:
New
types of evidence are being generated which, when we understand
them, create frequent, major changes in the way that patients
are being cared for. With the advent of the randomized
controlled trial came a change in the way clinicians establish
the clinical basis for diagnosis, prognosis and therapeutics.
By conducting randomized trials the efficacy of many treatments
have been confirmed. The flipside of this coin is that
the uselessness or harmfulness of many others have also
been confirmed.
Methods
of equal power have been developed and applied to determine
the usefulness and validity of clinical history, physical
examination, diagnostic tests and prognosis.
Secondly
although this new evidence is needed on a daily basis, clinicians
usually fail to get it. Even clinicians who try to
keep up do date with clinically important information, do not
always manage it as direct observations have shown.
Resulting
from what has been discussed in the previous paragraphs, both
the clinician’s up-to-date knowledge and clinical performance
deteriorate over time.
Trying
to overcome clinical entropy through traditional continuing
medical education programs does not improve the clinician’s
clinical performance. In the very busy society we live in other
ways needs to be found and developed to improve clinical
performance.
It
has been shown that a different approach to clinical learning
to keeps practitioners more up-to-date. This approach is
called evidence-based medicine or EBM for short.
A
good doctor will always make use of both his / her individual
clinical expertise as well as the best available external
evidence as neither alone is enough to provide really up-to-date
patient care.
The
practice of EBM is a process of life-long, self-directed learning
in which caring for your patients creates the need for
clinically important information about diagnosis, prognosis,
therapy and other clinical and health care issues, and
in which you:
- Convert
your information needs into answerable questions;
- Track
down, as efficiently as possible, the best evidence with which
to answer them (whether from the clinical examination,
the diagnostic laboratory, from the research evidence or
other sources);
- Critically
appraise the retrieved evidence for its validity (closeness
to the truth) and usefulness (clinical applicability);
- Apply
the results of this appraisal in clinical practice; and
- Evaluate
your own professional performance.
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