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What is Evidence Based Medicine (EBM)?

 

EBM is the combination of best research evidence, I.e. evidence that is often scientifically based; patient centred and can be used in day to day medical practice, with clinical (medical) expertise and patient values at its core.

 

Why are we interested in EBM?

 

These ideas have been around for a long time. In the current era, they were merged and named EBM in 1992 by a group led by Gordon Guyatt at McMaster University in Canada. Since then, the number of articles written has grown (from 1 publication in 1992 to about a thousand in 1998). International interest has led to the development of 6 evidence-based journals (published in up to 6 languages) that summarise the most relevant studies and have a combined world-wide circulation of over 175,000.

 

Why do we want to use EBM?

 

 

The rapid spread of EBM has arisen from the following:

• the need for valid information about diagnosis, prognosis, therapy and prevention
• the inadequacy of traditional sources for this information e.g. text books because they are out-of-date, experts who have been frequently wrong,
• the difference between our diagnostic skills and clinical judgment, which increase with experience, and our up-to-date knowledge and clinical performance which decline.
• our inability to afford more than a few seconds per patient or to set aside more than half an hour per week for general reading and study.

 

Until recently, these problems were overwhelming for full-time doctors. However, developments have allowed us to change things:

• the development of ways in which we can efficiently track down and assess the evidence for its strength and relevance.
• the creation of systematic (orderly) reviews and short summaries of the effects of health care.
• the creation of evidence-based journals.
• The use of IT to bring us the information in seconds.
• the identification of effective strategies for life-long learning and for improving our performance as doctors.

 

Improvements, Limitations & other uses of EBM

 

 

The examination of the idea and practice of EBM by doctors and academics has led to negative as well as positive reactions. Discussion and debate has reminded us of three limitations that are universal to science and medicine:

• shortage of logical, consistent scientific evidence
• difficulties in applying any evidence to the care of individual patients
• barriers to any practice of high quality medicine.

 

The debate has also identified limitations that are unique to the practice of EBM:

• the need to develop new skills in searching and critical assessment can be off-putting
• busy clinicians have limited time to learn and apply these new skills
• the resources required for instant access to evidence are often inadequate and evidence that EBM "works" has often been late and slow to come.

 

The discussion and debate has clarified other issues that arise from misunderstandings of the definition of EBM. Examination of the definition and steps of EBM dismisses the criticisms that it puts down clinical expertise, is limited to clinical research, ignores patients' values and preferences, or promotes a cookbook approach to medicine.

 

Moreover, it is not an effective cost-cutting tool, since providing evidence-based care directed toward maximizing patients' quality of life often increases the costs of their care. In addition, a great majority of front line GP's dispel the debate that EBM is an ivory tower concept, as they use this resource.

 

Several other uses of EBM have been recognized:

• It reinforces the need for the clinical and communication skills that are required to gather and critically assess patients' stories, symptoms, and signs. This allows the doctor to identify and incorporate patient's values and expectations into treatment plans.
• It encourages common skills for use in finding, assessing and applying evidence from the basic sciences and from other sciences.
• It provides an effective, efficient framework for post-graduate education and self-directed, life-long learning; when joined with "virtual libraries" and distance learning programs it supplies a model of worldwide applicability.

 

 

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