Where is the evidence...?

Although evidence-based medicine has undoubtedly been a force for good and has transformed clinical practice for the better, it has also been responsible for a subtle change in power dynamics when it comes to clinical policymaking.
It can sometimes feel like people use the word ‘evidence’ as a stick to beat us healthcare professionals with. Whether it’s university academics, guideline producers, governmental departments, or senior politicians, we’re often told that we’re doing something wrong and that they have some ‘evidence’ to discredit what we’re doing and force us to toe their line. Regardless of what our years of experience and common sense tell us, we must immediately change our practice or else the evidence stick will be used to beat us down until we repent.

But it doesn’t have to be like this. Although evidence-based healthcare has been a movement that has transformed the way we care for our patients - mostly for the better - it has also received much criticism. Clearly, the best available scientific evidence needs to inform our clinical decisions, but that doesn’t mean that it should dictate them. Many of the studies that form the evidence base, for example, come from secondary care populations, and the types of patients are often far different from the patients we see in general practice.

Just as importantly, each and every patient and family we see is unique, and have their own particular circumstances, which we can and should take into account. There may be events going on in their lives that completely change their goals and priorities, and it’s our job to understand those and react appropriately. Sometimes the science will be trumped by the things that matter most to our patients, and that’s just good, holistic practice.

The evidence stick is brutal

The evidence stick is brutal because it can be hard to respond to. If we’re told confidently and definitively that there’s evidence to support or reject an intervention, it can be difficult to challenge it, and intimidating to try and do so. But in actual fact, a lot of the evidence that we’re presented with has big holes in it, and can very much be challenged or critiqued with some careful reading.

The problem is, as busy healthcare workers in a pressurised system, we don’t always have time for the reading. Even when we do make time to read the journals and guidelines, it can be difficult to contextualise new findings within all the mountains of other pieces of information that are published each year, month, week, and even day. How can we synthesise all the new information that we’re given and make sense of how it will apply to us in our real-life consultations with patients every day?

The evidence stick is brutal because it can be hard to respond to. If we’re told confidently and definitively that there’s evidence to support or reject an intervention, it can be difficult to challenge it, and intimidating to try and do so. But in actual fact, a lot of the evidence that we’re presented with has big holes in it, and can very much be challenged or critiqued with some careful reading.

We can help you keep up-to-date

At NB Medical Education and Medcast, we get this. We get the challenges, we get the need for balance and common sense, and above all, we get how difficult it is to keep up with all the latest developments.

Over the last twenty years, we’ve been delivering courses to frontline healthcare staff across the NHS. Our ethos throughout this time has been to empower delegates to go back to their practices and be able to skilfully interpret and use the latest evidence in a productive and balanced way, taking into account all the nuances and context that comes with it. In healthcare, it sometimes feels like everything is a priority. And the problem with that, as we all know, is that when everything is a priority, then nothing is!

Our educational courses take our delegates through the most important topics in primary care at the moment, and highlight the key practice points for real-world practice. Perhaps most importantly though, they shine a light on the subtleties and limitations of the evidence, so delegates can go back to their practices fully equipped to use it in a constructive way to improve the lives of their patients.

For more information about our Australian Hot Topics GP Update 2019 dates, click here.

This blog was originally published via the NB Medical Hot Topics Blog, on 6th December 2018.

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Dr Ahmed Rashid

Ahmed is an NHS GP in Hertfordshire, a Senior Clinical Teaching Fellow at UCL Medical School and a Hot Topics presenter. He has a monthly research column in the British Journal of General Practice.

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