See the More detailed EBM section of this toolkit

The argument for evidence-based medicine

Taking an evidence-based approach to practice, teaching, and research can help you address some of the limitations of current medical practice.   It can help you:

It must not become a mantra, ignoring clinical experience or autonomy (of individual patients and Doctors)

Read Tricia Greenhalgh's critique "Intuition and EBM, uneasy bedfellows"

Abstract

Intuition is a decision-making method that is used unconsciously by experienced practitioners but is inaccessible to the novice. It is rapid, subtle, contextual, and does not follow simple, cause-and-effect logic.

Evidence-based medicine offers exciting opportunities for improving patient outcomes, but the 'evidence-burdened' approach of the inexperienced, protocol-driven clinician is well documented.

Intuition is not unscientific. It is a highly creative process, fundamental to hypothesis-generation in science.  The experienced practitioner should generate and follow clinical hunches as well as (not instead of) applying the deductive principles of evidence-based medicine.

 

            Also see the BMJ Christmas expose of EBM!

There is a balance, and even tension, between evidence and clinical expertise:

"Without clinical expertise, practice risks becoming tyrannized by external evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient.  Without current best external evidence, practice risks becoming rapidly out of date, to the detriment of patients." (Sackett, 1997)

Review the evidence based medicine course within this toolkit

"POEMs and DOEs

 POEM stands for "Patient Oriented Evidence that Matters", and refers to the kind of article that:

 

DOE stands for "Disease-Oriented Evidence".

   DOEs are all too common in the medical literature.  This kind of evidence is often misleading and generally should be considered premature.

  For example, early studies of the drug finasteride showed promise, based on the effect on the urinary flow rate.  Many patients were put on the drug, at great cost.  However, further randomized trials showed that symptom scores did not improve any more than placebo.  What do your patients care about - whether their urinary flow rate improved, or whether they are sleeping through the night? 

 When POEMs exist, forget the DOEs."

Marc Ebel

Resources 

Articles, Websites & Papers
 
 
Journals