Evidence-based medicine: what's the evidence?

At its core, evidence-based medicine is a systemic approach to utilizing the best scientific information to make decisions regarding diagnosis and treatment for individual patients. It involves learning a set of skills to access and evaluate the medical literature and select the most accurate information for use in clinical decision-making. The term " evidence-based medicine " (EBM) originated at McMaster University in Canada, and first appeared in the medical literature in 1992. 1 While the term may appear to be self-explanatory, its meaning and relevance to the practice of medicine in Saudi Arabia needs further discussion. The proponents of EBM believe that it is a marked departure from prevailing medical practice, which they consider to be hampered by the virtual impossibility of accessing and utilizing all the scientific evidence on any one question, leading to suboptimal decision-making in patient care. It is alleged that many clinical decisions are based on incorrect or inadequate evidence and outdated textbooks 2 and hence are incorrect. EBM is designed to help provide care for patients based on the best scientific evidence currently available. With the current interest in producing explicit practice guidelines, the importance of best scientific evidence becomes even more compelling. EBM is an appealing concept. It is absolutely logical for physicians to base their therapeutic and clinical decisions on the best scientific evidence. However, there are some particular assertions regarding EBM that remain unsubstantiated. 1. EBM will have a positive impact on physician performance as determined by improved patient outcomes. It has been demonstrated in a randomized clinical trial that conventional CME (Continuous Medical Education) had little impact upon the quality of patient care although knowledge in the experimental group rose substantially. 3,4 However, the same results may apply to the impact of EBM upon the elements of patient care that are necessary to produce improved patient outcomes. If there exists poor physician compliance with established guidelines, 5-7 there is no evidence that improved delivery of medical information as taught by the EBM " school " will improve compliance with these guidelines. It remains to be seen whether practicing clinicians who spend time in the library and are able to critically appraise the literature actually have better patient outcomes if they utilize evidence-based medicine. We are awaiting the evidence to demonstrate that evidence-based medicine really works. 2. EBM is something new. In reality, EBM in the form of the scientific method has …