A Brief Note on Evidence-Based Medicine

Those familiar with the concept of evidence-based medicine (EMB) know that it is defined by three intersecting areas of knowledge:

  1. best external evidence
  2. patient values and expectation
  3. individual clinical expertise

Although I want to cover the first two areas in future posts, let’s focus on individual clinical expertise for a moment.  I first heard this explained as the clinical experience that one brings to their practice.  However, this struck me as a nod to the previous days of eminence-based medicine – where time in the field and personal bravado determined what was the norm.

I don’t want to discount clinical experience.  The best way to learn is to work with patients and see what works and what does not.  However, we need evidence-based practice because we need to know what works, what works best, what is maybe wasting everyone’s time, and what is potentially harming our patients.  EBM cannot answer all of our questions, but it can and should serve as a guide in our evolving practices.

To serve as a guide, however, I believe we first have to clearly define “individual clinical expertise”.  It means a lot more than the expertise that you have gained while practicing as a clinician.  It also means your clinical expertise to understand and implement the best evidence and to evaluate and incorporate patient values and expectations.  To do this properly, we have to take the time to understand how to read, evaluate, and incorporate research.  Not all research is created equal and it can be easy to be fooled by a well-crafted paper (especially if it feeds into our confirmation bias) if we don’t understand the basic language of research.

I want this EMB 101 series to be a primer for individual clinical expertise so that we can become better clinicians by being better able to understand the complex world or research.  With that said, however, we also need to remember what I said earlier: EMB cannot answer all of our questions.  We have to accept the fact that it can inform our practice, but much of what we do must still be defined by clinical experience, educated guesswork, and ambiguity.

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