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The Principles of Evidence-Based Medicine

Evidence-based medicine, or EBM, integrates clinical expertise with the best clinical evidence available. It seeks to utilize the best evidence in order to make the right decision for the individual patient. As this method is generally regarded as a more conscientious way to treat a patient, its implementation is on the rise. Evidence-based medicine may be used to treat arthritis pain.

Clinical expertise can be defined as the sum total of the experience, education, as well as the clinical skills that a clinician has accumulated over the years. The best evidence is established from a related clinical research that is conducted with the use of scientific methodology. The patient, on the other hand, contributes to the diagnosis or prognosis by lending his personal viewpoint, concerns, and expectations to the clinical process.

The origin of evidence-based medicine can be traced back to the times of the ancient Greeks. However, some experts feel that it was the ancient Chinese medical practitioners who set off EBM. It was only in the last century that a structured effort was made to propagate EBM. One of the modern proponents of EBM was the Scottish epidemiologist Professor Archie Cochrane. He published a book in 1972 called Effectiveness and Efficiency: Random Reflections on Health Services to help create awareness for EBM among the medical fraternity.

In evidence-based medicine, the evidence itself does not provide the answer to a patient’s problem; rather, it is the culmination of clinical evidence, values, and clinical experience that eventually helps make the correct decision. During the discussion with the patient, certain important queries have to be clarified, such as the effects of a prescribed therapy, the long-term benefit of a diagnostic test, and the prognosis of the patient’s disease.

It is not an easy task to be an evidence-based medicine practitioner. A clinician requires certain skills, such as the abilities to research medical literature and apply sound medical rules, when he is carrying out the EBM. Clinicians are often required to ask clinical questions. Four of the most important questions in EBM are referred to as the PICO questions. They comprise of Patient and Problem, Intervention, Comparison, and Outcome. The answers usually determine the therapy or diagnosis that has to be administered to the patient.

There are two branches of EBM, namely, evidence-based guidelines (EBG) and evidence-based individual decision (EBID). EBG refers to the practice of EBM at the institutional level whereas EBID is concerned with the practice of EBM by an individual clinician or health care provider.

Over the years, there have been a number of proponents as well as critics of EBM. The proponents believe that EBM formalizes and sharpens the decision making process. It helps to filter the medical literature in order to arrive at a decision, which is absent in a regular clinical process. On the contrary, critics believe that EMB neglects clinical judgement, and it is over-reliant on evidence. They also feel that the evidence gathered through EBM is too generic, and it doesn’t always address the individual’s specific health problem.

Besides the quintessential The Users’ Guides to the Medical Literature, there are dozens of medical journals as well as a handful of valuable guides for clinicians who wish to integrate evidence-based medicine into their medical practice.

For more information:

• CEBM: Website of the UK-based Centre for Evidence-Based Medicine

• Tutorial on EBM: A self-paced tutorial on EBM from the Duke University Medical Center Library

• EBM New York: EBM resource centre. Includes several useful links

Resource Article

The Principles of Evidence-Based Medicine

Evidence-based medicine, or EBM, integrates clinical expertise with the best clinical evidence available. It seeks to utilize the best evidence in order to make the right decision for the individual patient. As this method is generally regarded as a more conscientious way to treat a patient, its implementation is on the rise. Evidence-based medicine may be used to treat arthritis pain.

Clinical expertise can be defined as the sum total of the experience, education, as well as the clinical skills that a clinician has accumulated over the years. The best evidence is established from a related clinical research that is conducted with the use of scientific methodology. The patient, on the other hand, contributes to the diagnosis or prognosis by lending his personal viewpoint, concerns, and expectations to the clinical process.

The origin of evidence-based medicine can be traced back to the times of the ancient Greeks. However, some experts feel that it was the ancient Chinese medical practitioners who set off EBM. It was only in the last century that a structured effort was made to propagate EBM. One of the modern proponents of EBM was the Scottish epidemiologist Professor Archie Cochrane. He published a book in 1972 called Effectiveness and Efficiency: Random Reflections on Health Services to help create awareness for EBM among the medical fraternity.

In evidence-based medicine, the evidence itself does not provide the answer to a patient’s problem; rather, it is the culmination of clinical evidence, values, and clinical experience that eventually helps make the correct decision. During the discussion with the patient, certain important queries have to be clarified, such as the effects of a prescribed therapy, the long-term benefit of a diagnostic test, and the prognosis of the patient’s disease.

It is not an easy task to be an evidence-based medicine practitioner. A clinician requires certain skills, such as the abilities to research medical literature and apply sound medical rules, when he is carrying out the EBM. Clinicians are often required to ask clinical questions. Four of the most important questions in EBM are referred to as the PICO questions. They comprise of Patient and Problem, Intervention, Comparison, and Outcome. The answers usually determine the therapy or diagnosis that has to be administered to the patient.

There are two branches of EBM, namely, evidence-based guidelines (EBG) and evidence-based individual decision (EBID). EBG refers to the practice of EBM at the institutional level whereas EBID is concerned with the practice of EBM by an individual clinician or health care provider.

Over the years, there have been a number of proponents as well as critics of EBM. The proponents believe that EBM formalizes and sharpens the decision making process. It helps to filter the medical literature in order to arrive at a decision, which is absent in a regular clinical process. On the contrary, critics believe that EMB neglects clinical judgement, and it is over-reliant on evidence. They also feel that the evidence gathered through EBM is too generic, and it doesn’t always address the individual’s specific health problem.

Besides the quintessential The Users’ Guides to the Medical Literature, there are dozens of medical journals as well as a handful of valuable guides for clinicians who wish to integrate evidence-based medicine into their medical practice.

For more information:

• CEBM: Website of the UK-based Centre for Evidence-Based Medicine

• Tutorial on EBM: A self-paced tutorial on EBM from the Duke University Medical Center Library

• EBM New York: EBM resource centre. Includes several useful links