To best understanding the evidence-based medicine (EBM) definition we can look at an example. Your doctor has treated dozens of patients during her 10-year career. She has observed carefully which treatments work and which don’t. Her observations have spurred her to make recommendations to patients. All of her patients are now taking the medicines that have had the highest percentage of success in her previous patients -- and in the doses that had the highest percentage of success.
Now, your doctor has made a recommendation about how to treat your cancer. She carefully explained how several of her patients fared well with the same treatment, while other patients lived longer than patients who underwent other treatments. Although you were only diagnosed with cancer a week ago, you completely trust your doctor because all of the medical advice she has given you during her eight years as your doctor has worked.
Your natural -- and perfectly understandable -- inclination is to accept your doctor’s recommendation. Unfortunately, your inclination might be completely wrong. In fact, your doctor’s reliance on personal observation might be harming some of her patients -- and could harm you. What your doctor should be doing is basing her decision on evidence or proven medicines and treatments.
"EBM emphasizes the importance of the results of large clinical trials in formulating individual treatment strategies," reports an article in the Journal of Managed Care Pharmacy. "EBM uses scientific evidence that is rigorously obtained — and this contrasts with anecdotal experience, which can be biased, since even the most knowledgeable physician can be influenced in the decision-making process by recent experience with patients."
Basically, your doctor -- and many other doctors -- are making decisions based on what worked with relatively few patients. Why should doctors make decisions based on the results of the care of dozens of patients when there is data on the results of the care of thousands of patients? Evidence-based medicine says they shouldn’t. It’s possible, for example, that large clinical trials show that one treatment on heart disease works better on men than women while another treatment works better on older people than younger people, and other specific treatments work better on people with specific kinds of heart problems.
It’s also possible that doctors making decisions based on their personal and clinical experience are relying on too small a sample size for their conclusions to have any scientific validity. Perhaps, your doctor hasn’t treated any individuals who are the same age, gender, and size as you are and is in the same medical condition. Does that matter? A large clinical trial of thousands of patients might have the answer to that question -- and might show what specific treatment works for people who are specifically like you.
"The advantage of EBM is that the knowledge gained from large clinical trials is applied directly to patient care," the Journal of Managed Care Pharmacy article reports. "Use of EBM promotes consistency in individual patient treatments that assume optimal clinical outcomes and improved quality of life."
Evidence-based medicine also relies on systematic reviews of clinical trials -- reviews of the literature that were based on the trials -- points out an article in EuroScientist. These reviews "add rigour to appraisals of the value of evidence presented in past studies," the article reports.
Another advantage of evidence-based medicine is that it incorporates patients’ values and preferences. The research-based evidence not only provides more information to doctors, but also provides more information to patients. In other words, you the patient have the opportunity to study and review the results of clinical trials and discuss them with your doctor.
"5 Reasons the Practice of Evidence-Based Medicine Is a Hot Topic (Part 1)," is an article stating that evidence-based medicine "encourages" conversations between doctors and patients that result in patients having more input in the decisions about treatment than medicine based only on a doctor’s personal observations and clinical experience. "The benefit of this approach: patients feel their doctors are listening to their concerns and taking those concerns into consideration when determining the treatment plan," the article reports.
It should be pointed out that clinical experience -- your doctor’s knowledge and skill -- is also part of evidence-based medicine. That’s a good thing. Your doctor should be a crucial part of the finding the best treatment equation. The benefit of evidence-based medicine is that it helps your doctor by giving him or her more information.
All the factors that go into evidence-based information help healthcare professionals achieve what many of them call the Triple Aim -- improved quality, improved patient satisfaction, and reduced costs. The cost factor should not be overlooked.
“Substantial variations in health care services have been well documented in the United States and abroad,” reports an article in HealthAffairs. The net result is that increased health care spending is not uniformly associated with improvements in patients’ health status."
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