Trial Lawyers - What is evidence based medicine?
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Evidence based medicine is a medical concept that is being peddled to the legal profession, but especially the Courts as a fairer approach to deciding what evidence should or should not be admitted into evidence. It's a medical concept that some are attempting to turn into a legal concept. There are several definitions. A few are cataloged below.
There is even a Centre For Evidence-Based Medicine that is said to have been established in Oxford in 1995. "EBHC requires the integration of the best available research evidence with
our clinical expertise and our patient's unique values and circumstances."
What this all boils down to is what a medical expert is supposed to do before arriving at an opinion.
Step 1: Start with the patient or clinical problem or question that involves medicine.
Step 2: Construct a well built question derived from the case.
Step 3: Select the appropriate resources and conduct a search of the literature.
Step 4: Appraise the evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice).
Step 5: Return to the patient or question and integrate that evidence with clinical expertise, patient preferences and apply it to the practice.
Step 6: Evaluate the performance with the patient or question.
"Evidence-Based Medicine is ... a set of procedures, pre-appraised resources and information tools to assist practitioners to apply evidence from research in the care of individual patients." - K.A. McKibbon, McMaster University
MedicineNet.com quotes Dr. Sackett from McMasters University in Canada as follows: Evidence-based medicine: The judicious use of the best current evidence in making decisions about the care of the individual patient. Evidence-based medicine (EBM) is mean to integrate clinical expertise with the best available research evidence and patient values. EBM was initially proposed by Dr. David Sackett and colleagues at McMasters University in Ontario, Canada.
British Medical Journal - Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice. Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients' predicaments, rights, and preferences in making clinical decisions about their care. By best available external clinical evidence we mean clinically relevant research, often from the basic sciences of medicine, but especially from patient centred clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens. External clinical evidence both invalidates previously accepted diagnostic tests and treatments and replaces them with new ones that are more powerful, more accurate, more efficacious, and safer.
Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannised by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best evidence, practice risks becoming rapidly out of date, to the detriment of patients. BMJ 1996;312(7023):71 (13 January)