Moving forward in the use of evidence based medicine in the clinical setting

Steve Budsberg, DVM, MS, DACVS

Professor, Department of Small Animal Medicine Surgery; Director of Clinical Research; College of Veterinary Medicine, University of Georgia, United States

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Abstract

It is clear over the last decade that evidence based medicine (EBM) advocates have focused on promoting the concepts and ideals of EBM as well as teaching the skills needed to use it efficiently and effectively. With this knowledge and education there has been emergence of a significant number of perceived barriers that seem to prevent the clinician from implementing EBM.

Remember, at its’ core EBM attempts to take the results of population studies and apply them to an individual patient. This is in stark contrast to traditional medical practice in which clinical experience (often from individual patients) is commonly used to define and defend the treatment of an entire group of patients with a similar problem. Thus it is apparent that promoting this paradigm shift must emphasize the fact that these data must however be combined with the knowledge of the individual patient/client and the experience of the clinician. When clinicians read and think about evidence based medicine (EBM), thoughts that often come to mind are “how does this really affect me and if I want to use EBM, how I can do this in my daily practice?” It is important to remember the evidence (data), by itself, does not make a decision for you, but it can help support the patient care process.

We must now focus on the process of encouragement of collaboration by means of positive and safe communication and shared learning across career stages to overcome these barriers. Recent studies suggest that these types of proactive steps will facilitate the uptake of EBM and reduce cognitive and affective biases in clinical decision-making. Thus, we need look critically at all the pros and cons of EBM and move forward, not as evangelical preachers or high minded academics but as colleagues and mentors to work to improve the use of all the data available when treat our patients.

In the next few years, as clinical trial data continues to increase, we must guide and instill in individuals at all levels of their professional careers a sense of how EBM can benefit them when used judiciously and correctly.


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