Evidence Based Practice
How should things be done? How do we measure up? What can I learn?
Identify something behind which there is a good evidence base, read about it and apply it to your practice.
You may look at local hospital guidelines. Do they match available evidence? How do you manage this disease in your practice or your PCO? Should you adapt your management? Involve the team in developing your own local care pathway.
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)
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 Without current best external evidence, practice risks becoming rapidly out of date, to the detriment of patients."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
Review the Centre for evidence based medicine files
"POEMs and DOEs
POEM stands for "Patient Oriented Evidence that Matters", and refers to the kind of article that:
- addresses a clinical problem or clinical question that primary care physicians will encounter in their practice
- uses patient-oriented outcomes
- has the potential to change our practice if the results are valid and applicable
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