Dr. Gerstmar's Thoughts on Health, Happiness, and Well-Being from Aspire Natural Health

Part II here

Part III here

Evidence based medicine (EBM) has emerged as one of the key concepts being debated in leading medical journals, doctors offices and conventions, insurance boardrooms, and government agencies  as a major piece of  the effort to reduce costs and improve outcomes in medicine.  In this series I’ll be explaining what evidence based medicine should be (part I), is (part II), and how I use it in my practice (part III).

The definition of evidence based medicine I believe makes the most sense comes from this paper.  BMJ 1996;312:71-72 (13 January) Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS (1996). “Evidence based medicine: what it is and what it isn’t”. Excerpts from the paper will be in italics.

“Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”

The intention behind evidence based medicine is a good one.  As doctors we want to carefully and consciously use the best evidence to select therapies that are helpful to patients, and avoid those which are harmful or useless.  As the article says:

“[The purpose of evidence based medicine is to] invalidates previously accepted diagnostic tests and treatments and replaces them with new ones that are more powerful, more accurate, more efficacious [effective], and safer.”

Whatever gives us the best results is what we want to use for the good of our patients.  But, how do we decide what is the best evidence?

“The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”

We combine our clinical experience as doctors (personal, subjective evidence) with the best evidence from external sources (impersonal, objective experience).   In contrast to what we will see in part II of this series, we see that evidence based medicine combines the clinical experience of the doctor with external sources, such as the scientific literature.

The article continues: “Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannised by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best evidence, practice risks becoming rapidly out of date, to the detriment of patients.”

In this view of evidence based medicine, which I subscribe to, both clinical experience and the scientific literature are equally important.  One without the other is insufficient and leads to poor practice and outcomes.  Clinical experience without external evidence is narrowly focused and becomes quickly out of date, and the external evidence without clinical experience attempts to fit a “one size fits all” solution to individuals, which typically works very poorly.

In part II, we’ll move away from what EBM should be, to what it most often is.

What are your thoughts and opinions on EBM?  We’d love to hear them.  Feel free to share them below.