KISS Guide to Evidence Based Medicine 2020
Many students, trainees and GPs have a fear of research, and its associated complex terminology and statistics.
This is no surprise as GPs generally prefer people to numbers, which is what attracts them to GP in the first place! But to help patients through our clinical care and crucially to help to protect them from potential harm, understanding what the terms and the numbers mean is vital to enable us to take a more evidence-informed approach to clinical care.
Crucially, it also empowers us with a more critical eye with which to review the literature and the exaggerated claims often made for treatments in the media. Exam candidates commonly worry but with some simple tools and knowledge you can pick up easy marks here.
What is evidence-based medicine?
Definitions vary, but possibly the best is: ‘EBM is defined as the integration of the best available evidence with our clinical expertise and our patients’ unique values and circumstances’ (Strauss and Haynes, EBM200712:1).
So, whilst the maths and statistics are important, just as important are your clinical judgement and the patient’s wishes.
The evidence may say that your patient would benefit from drug X, but if your clinical judgement is that it would be unsafe or she does not want to take it, are you are still practicing EBM by not prescribing?
EBM then involves a 3 step approach of:
- Asking an answerable clinical question e.g. using PICO (see below)
- Gather the evidence and critically appraise it (see critical appraisal below)
- Making a decision by integrating this evidence with your clinical opinion and the patient’s values and circumstances, using a shared decision-making approach
Despite this definition of EBM which clearly incorporates clinical judgement and patient values, a culture has developed over the years whereby evidence can seem to ‘trump’ clinical judgement or patients are not enabled to make truly informed decisions. It also can be criticised for being overly simplistic, in that most clinical questions (especially in patients with multimorbidity) cannot be distilled down to a single answerable question.
Each patient and each clinical encounter are unique, and however good a clinical trial is it will never tell you with certainty whether a drug or intervention will help the patient sitting in front of you. Clinical practice, especially in primary care, is inherently complicated and ‘messy’.
For this reason, many GPs prefer the term ‘evidence informed’ medicine, and this is very much the ethos we follow at NB Medical Education: clinical care should be patient-based first and foremost but informed by the best quality evidence.
For more detailed information, we would strongly recommend GP Dr Chris Cates’ excellent site www.nntonline.net and the CEBM pages.
Click here to download the KISS: Guide to Evidence Based Medicine 2020.
But wait... there's more!
As part of the NB Medical / Medcast Hot Topics workshop series, we produce a range of KISS summaries. From time to time, we will be sending these out as 'tastes' of the workshops. By attending a live workshop or webinar, you receive an up to date workbook of 150 evidence based summaries, reviewed yearly and localised for Australia.
Independent education, Australian & international evidence reviewed and summarised into useful 'chunks' by expert GPs, for GPs.
Simon is the Medical Director NB Medical Education, an NHS GP in Oxford and Hon Senior Clinical Lecturer in General Practice, Oxford University.
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