Evidence Based Medicine
Evidence Based Medicine is typically defined as an approach to healthcare practice in which the clinician is aware of the evidence in support of his/her clinical practice and the strength of that evidence.
As per the Center for Evidence-Based Medicine, “Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.”
To achieve its purpose, the concept of EBM employs a series of techniques from the fields of science, engineering and statistics. Some of these include meta-analysis of scientific literature, risk-benefit analysis and randomized controlled trials.
Evidence Based Medicine is being regarded as a new paradigm, replacing the traditional medical paradigm that is almost exclusively based on authority.
Analyzing the concept further, there are three key areas of the practice of EBM, listed as below:
- To treat individual patients with acute or chronic pathologies with treatments supported in the most scientifically valid medical literature
- To carry out a systematic review of medical literature to evaluate the best studies on specific topics.
- To view evidence-based medicine as a ‘medical movement’, where the activists work to popularize the method and usefulness of the practice in consumer and medical groups.
The entire model of EBM is based on innovative steps devised to instill a scientific approach in medical care. It is the integration of clinical expertise, patient values and the best evidence into the decision making process for patient care.
Though the evidence itself does not make a decision, but it supports the overall patient care process. The full integration of these components into clinical decisions enhances the opportunity for optimal clinical outcomes and quality of life.
Moreover, physicians are constantly faced with the task of interpretation of diagnostic tests, the efficacy of therapeutic intervention, the harm associated with a specific drug, the course and prognosis of a disease in a particular patient and so on. In such cases, it is critical for the physician to know that the advice in practice guidelines is sound and the conclusions form systematic views are valid.
A study of information-seeking habits of physicians by Covell DG (1995) revealed that their routine practice generated about 2 questions for every 3 patients. However, only 30% of physician’s needs were met during the patient’s visit, further calling upon the need of systematic implementation of the EBM tools.
Steps in the EBM Process
For a planned EBM process, generally the below steps are followed:
- Start with the patient – a clinical problem or question arises out of the process of patient care
- Construct a well-built clinical question derived from the case
- Select the appropriate resource and conduct a search
- Appraise the evidence for its validity and applicability
- Return to the patient – integrate that evidence with clinical expertise, patient preference and apply it to the practice
- Evaluate your performance with this patient