Evidence Based Medicine

Evidence Based Medicine

The words “evidence-based” are used to describe lots of things in medicine, healthcare and beyond. Evidence-based medicine (EBM), evidence-based practice, evidence-based policy, and – in a different part of society – evidence-based social work and evidence-based education.

The underlying principals are the same. The concept is about making sure that when decisions are made they are made on the basis of the most up-to-date, solid, reliable, scientific evidence. In the case of medicine or health care, these are the decisions about the care of individual patients.

A simple definition from 1996 is:

"Evidence-based medicine is the conscientious explicit and judicious use of current best evidence in making decisions about the care of individual patients." [1]

A good example of Evidence-based Medicine is the journal T.E.N. — Trends in Evidence-Based Medicine, edited by Myrna Weissman, PhD.

What is the best decision?

Every part of this sentence is important. Consider the words themselves:

What sort of evidence are we looking for? “Current best evidence”. Not perfect evidence – simply, the best there is. But not old or out-of-date evidence; we need to find modern, up-to-date current evidence.

How is this to be done? In a conscientious, explicit and judicious way. Again, the words are important.

Conscientious – being careful, and thorough, in what you do

Explicit – being “up-front”, open, clear and transparent

Judicious – using good judgement and common sense

If you are going to practice in this way, you have to be able to find evidence from scientific studies that are relevant to your patients. You then have to understand those studies and be able to appraise them (not all studies will be relevant to your patient and even if they are, they may not be good studies). And finally you have to apply those results when making decisions about your patient. This means being able to integrate the evidence with your patients personal needs, their values and beliefs and their wishes.

So an alternative definition of evidence-based practice would be:

"Evidence-based practice is the conscientious explicit and judicious use of current best evidence in helping individual patients make decisions about their care in the light of their personal values and beliefs"