Misunderstandings, misperceptions, and mistakes

ebm_logo.gif  From  the February 2007 issue of Evidence-Based Medicine: [subscription required]

Straus S, Haynes B, Glasziou P, Dickersin K, Guyatt G. Misunderstandings, misperceptions, and mistakes. Evid Based Med 2007; 12(1):2-a.

Excerpt: Discussions about evidence-based medicine (EBM) have engendered both positive and negative reactions from clinicians, researchers, and policymakers since the term was first coined in the early 1990s. These discussions were brought to the forefront again in a recent commentary by Dr Bernadine Healy, former director of National Institutes of Health, in U.S. News & World Report. She raised several issues that EBM practitioners and teachers face when advocating this model of care. Firstly, she stated that EBM practitioners advocate using the “best” evidence which is mostly taken from randomised trials and cost benefit studies. Secondly, she raised the issues of the interpretation of evidence for screening mammography and prostate specific antigen as examples where EBM has failed because EBM proponents did not advocate for these tests based on the available evidence. Thirdly, she likened the practice of EBM to a “straitjacket” or a cookbook approach in . . .

Scott I. The evolving science of translating research evidence into clinical practice. Evid Based Med 2007; 12(1):4-7.

Practising clinicians have to swim in an ocean of clinical research evidence that varies in rigour, consistency, and applicability to the care of individual patients. They are expected to stay up to date, be authoritative, and practice to a high standard. They work in an environment that obliges them to reconcile patient preferences and societal/professional expectations with the need for cost restraint and accountability for quality and safety of care.

Numerous reports of variations in practice patterns and substandard care have placed increased pressure on clinicians, healthcare institutions, and professional organisations to improve their ability to provide optimal care. This is essential for the continuation of public trust and funding from public and private payers. While standards of care may not be definable in the absence of definitive evidence, the fact that clinical practice in many instances appears to be at odds with even clear-cut research evidence has . . .


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