Evidence-based medicine (EBM) is an important change in the way physicians practice, teach, and do research. It was initially proposed by Dr. David Sackett and colleagues at McMasters University in Ontario, Canada. Dr. Sackett defines EBM as:
"...the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients." (Sackett, 1997)
Sackett realizes that evidence alone is not sufficient for the compassionate, effective care of patients. He stresses that the practice of EBM requires that it be integrated with clinical expertise, which brings the following important elements:
The balance, and even tension, between evidence and clinical expertise is summarized by Sackett:
"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 Without current best external evidence, practice risks becoming rapidly out of date, to the detriment of patients."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)
Taking an evidence-based approach to the care of patients is an intellectually exciting style of practice, which leads you down a path of exploration and lifelong learning. It gives you a framework for knowing when to adopt new tests and therapies, when to discard old ones, and how to look for answers to the clinical questions that arise every day in the care of patients.
An evidence-based approach also liberates you from a reliance on dogma and tradition, and it allows you to critically evaluate both traditional and alternative or complementary therapies in an even-handed manner. While strict pathophysiologic reasoning is not abandoned, it is reserved for those times when evidence that uses patient-oriented outcomes is lacking. EBM puts the patient at the center of care by emphasizing outcomes that matter to patients such as symptoms, morbidity, mortality, quality of life, and even cost.
In this module, we will: