Evidence Based Medicine

The most common definition of evidence based medicine (EBM) is taken from Dr. David Sackett. EBM is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external evidence from systematic research. Sackett, D. 1996 Evidence-based Medicine - What it is and what it isn't.

Example strategy for the caregiver

  1. Start with the individual -- a clinical problem or question arises out of a person's care
  2. Propose an hypothesis derived from the case
  3. Select the appropriate resource(s) and conduct a search for evidence
  4. Appraise the evidence for its integrity and relevance
  5. Return to the individual -- integrate that evidence with clinical expertise and patient preferences
  6. Document what is the expected consequence of the intervention for this individual
  7. Evaluate your performance with this patient

Example questions from the patient to the caregiver

How does the balance of risk versus benefit of my proposed clinical service rank? What is the evidence on which this information is based?

Your caregiver should be able to provide one of these possible answers:

  1. Good scientific evidence suggests that the benefits of the clinical service substantially outweigh the potential risks. Ask to see a study report.
  2. At least fair scientific evidence suggests that the benefits of the clinical service outweigh the potential risks. Ask to see a study report.
  3. At least fair scientific evidence suggests that there are benefits provided by the clinical service, but the balance between benefits and risks are too close for making general recommendations. Ask your caregiver what individual considerations have had importance in your particular case. Ask about other options.
  4. At least fair scientific evidence suggests that the risks of the clinical service outweigh potential benefits. Ask your caregiver what individual symptoms have had importance in your particular case. Ask about other options.
  5. Scientific evidence is lacking, of poor quality, or conflicting, such that the risk versus benefit balance cannot be assessed. Ask your caregiver to explain the uncertainty surrounding the clinical service. Ask about other options.