Evidence-Based Medicine

What is evidence-based medicine (EBM)?

Evidence-based medicine is defined as “the conscientious, explicit and judicious use of current best medicine in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research” by David L. Sackett and his colleagues.

It has been simplified over time to be “the integration of best research evidence with clinical expertise and patient values”.

Myths about evidence-based medicine

Evidence-based medicine is not a new concept. The term evidence-based medicine was coined in 1992 by a group at McMaster University, but clinicians have always used evidence to make decisions about patient care. The evidence just may not have been the “best” evidence due to any number of reasons.

Some fear that EBM is an example of cookbook medicine, a way to cut costs of health care, or a way to keep patients from receiving the care they deserve. None of these fears is true. There will never be one recipe that fits all patients, and as stated clearly in the definitions above, EBM involves integration of clinical expertise and individual patient values. In some cases, the results of EBM may cut costs by eliminating unnecessary procedures or treatments; however there also may be situations where it is the expensive procedure or treatment that provides the best results for patients. Along that same line, practicing EBM is a way to eliminate unnecessary expenditure which in theory would allow more money to decrease the treatment and diagnostic disparities that are present in today’s society.

Many can agree with the concept of EBM but are unsure that it can be practiced in a busy clinic. In reality, it is those busy clinicians who can benefit the most from the growth of EBM. As the search engines become quicker and the number of secondary sources grows, it will be easier than ever to find the answer to a clinical question that arises from a fifteen minute office visit.

The need for evidence-based medicine

Studies suggest our need for best evidence occurs twice in every three outpatient visits and up to five times per inpatient visit. The amount of new medical information formed daily is overwhelming. It is impossible to know everything. With this rapid formation of data, familiar sources such as textbooks are out of date by the time they reach the shelf. The development of online EBM tools and journals containing pre-analyzed articles help individual providers keep current.

Most importantly, practicing evidence-based medicine leads to improved patient outcomes.

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