EVIDENCE-BASED MEDICINE Evidence-Based Medicine: Past, Present, and Future

WHAT IS EVIDENCE-BASED MEDICINE? Evidence-based medicine (EBM) differs from prior approaches to medical practice in several important ways. It puts a greater emphasis on using published literature to solve medical problems, posits an explicit hierarchy of evidence, suggests specific guidelines for the interpretation of evidence from the medical literature, and offers an approach to resolve medical problems that explicitly acknowledges the role of patient values and preferences. I am not suggesting that all of these elements were not, to varying degrees, part of conventional medical practice. Nor am I suggesting that they have been absent from the writings of various authors, both ancient and recent, prior to 1990. EBM does, however, represent an important change in emphasis and, increasingly, a systematic approach to clinical problem-solving.