Understanding what Evidence-Based Medicine is remains crucial to its application to improving patient care.
In 1992 the Evidence-Based Medicine Working Group reported in JAMA : ‘Evidence-based medicine de-emphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision making and stresses the examination of evidence from clinical research.’
Because of the prominence given to ‘de-emphasizing’, I find this definition somewhat unhelpful. For instance, the article reports: the development of clinical instincts (particularly with respect to diagnosis) are a crucial and necessary part of becoming a competent physician, which is at odds with reducing the importance of intuition.
In 1996, the BMJ published a lead editorial by Dave Sackett on Evidence-Based Medicine: what it is and what it isn’t. Outlining the definition of EBM as: ‘the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.’
By stressing the important components of EBM it became clearer that evidence, values and expertise have similar roles to play in overall clinical decision making. However, a number of definitions have, unhelpfully, gone onto emphasize the use of evidence alone for decision making:
E.g., Wikipedia, Dec 9th, 2009: ‘Evidence-based medicine (EBM) is an approach to medical practice intended to optimize decision-making by emphasizing the use of evidence from well designed and conducted research.’
Moreover, Evidence-based has become a term used so widely – 96 500 000 results on google – you can find it in all sorts of areas. From insurance companies, to management and even a journal for evidence based design! Therefore, although decisions can be based on evidence, it cannot necessarily be evidence-based. Mainly, as I am not sure what is meant by the term, particularly when it turns up as ‘evidence-based recommendations’ and given it used so widely. However, the good news is that decision making based on evidence is hard wired into society – not the case 20 years ago.
One problem, though, with the definition of EBM is its restriction to clinicians. Evidence-Based Health Care (take a look in the Centre’s 1996 prospectus) is about extending the principles, strategies, and tactics of evidence-based decision-making to other health professionals, to public health practitioners, to health planners and purchasers, to health policy makers, to health administrators and managers, and to consumers. Basically…….everyone.
However, what the definition of EBM does not encompass, is all those who contribute to EBM through the undertaking of research and teaching. This is important, as current problems with the evidence-base (note this is not the same as evidence-based) are substantial, and limiting its use and application to patient care. Why we have Theme 1 of the EvidenceLive conference: Improving the Quality of Research Evidence
Therefore, I have added one word to the current definition. Aiming to encompass all those who contribute through the development of high quality evidence to use in individual patients.
The conscientious, explicit, and judicious development and use of current best evidence in making decisions about the care of individual patients.
What’s in a name? Quite a lot when you think about it.
Shifting the paradigm for the “E” in EBM discusses what can be done to address the problem biases, which may distort the design, execution, analysis and interpretation of research to better support evidence-based practice.
Abstracts are sought that focus on:
• Current conduct of trials – shortfalls and methods for improvement.
• Publication bias, withholding of results and how barriers to access might be overcome.
• Problems around scientific integrity and conflicts of interest and solutions to reduce them.
• Focus on biases which may distort the design, execution, analysis and interpretation of research.