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Evidence-Based Medicine: Adjusting to a Culture Shift in Health Care

by Bradley F. Marple, MD • October 1, 2008

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In point of fact, EBM has responded and evolved substantially since that time, as it has become more practical in its integration with traditional medicine. The emphasis now focuses on integrated decision making by the clinician. Perhaps this is best stated by one of the pioneers of EBM, Brian Haynes, MD, PhD:

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Explore This Issue
October 2008

As we continue our journey through the era of research-informed health care, the benefits that our patients will receive will depend increasingly on making care decisions that incorporate the clinical state and circumstances of each patient, their preferences and actions, and the best current evidence from research that pertains to the patient’s problem. The nature and scope of clinical expertise must expand to balance and integrate these factors.15

So, rather than a culture shift, it appears that the emergence of EBM marks an evolutionary step in the methodological approach to information processing. Increasingly available high-grade evidence provides sound information that can play a role in clinical decision making, but is not intended to replace physician experience and other forms of information. Indeed, in the era of research-enhanced health care, it remains prudent to still consider all information that is available.

References

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  2. Paris J. Evidence-based psychiatry: what it is and what it isn’t. CPA Bulletin 2002;34:32-4.
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  3. Jenkins TR. It’s time to challenge surgical dogma with evidence-based data. Am J Obstet Gynecol 2003;189;423-7.
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  4. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence-based medicine: what it is and what it isn’t. BMJ 1996;312:71-2.
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  5. Hitt J. Evidence-Based Medicine. New York Times Magazine, Dec. 9, 2001.
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  6. Cohen AM, Hersch WR. Criticisms of evidence-based medicine. Evid Based Cardiovas Med 2004;8:197-8.
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  7. Buetow S, Upshur R, Miles A, Loughlin M. Taking stock of evidence-based medicine: opportunities for its continuing evolution. J Eval Clin Prac 2006;12:399-404.
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  8. Harari, E. Whose evidence? Lessons from the philosophy of science and the epistemology of medicine. Aust NZ J Psychiatry 2001;35:724-30.
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  9. Haynes RB. What kind of evidence is it that evidence-based medicine advocates want health care providers and consumers to pay attention to? BMC Health Serv Res 2002;2:3.
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  10. Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB. Evidence-Based Medicine: How to Practice and Teach EBM. Edinburgh: Churchill Livingstone, 2000.
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  11. Benson K, Hartz AJ. A comparison of observational studies and randomized, controlled trials. N Engl J Med 2000; 342:1878-86.
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  12. Upshur RE, VanDenKerkhof EG, Goel V. Meaning and measurement: an inclusive model of evidence in health care. J Eval Clin Prac 2001;7:91-6.
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  13. Goodman KW. Ethics and Evidence-Based Medicine: Fallibility and Responsibility in Clinical Science. Cambridge: Cambridge University Press, 2003.
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  14. Jones GW, Sagar SM. Evidence-based medicine. No guidance is provided for situations for which evidence is lacking. BMJ 1995;311:258.
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  15. Haynes RB, Devereaux PJ, Guyatt GH. Clinical expertise in the era of evidence-based medicine and patient choice. Evidence-Based Medicine 2002;83:383-6.
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©2008 The Triological Society

Pages: 1 2 3 4 | Single Page

Filed Under: Departments, Health Policy, Medical Education Tagged With: culture, diagnosis, evidence-based medicine, healthcare reform, policy, Quality, research, treatmentIssue: October 2008

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