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I’m sure readers of the Evidence-Based Medicine journal have a variety of reasons for subscribing. But most of you would assume evidence-based medicine (EBM) is important to clinicians. Recently Olive Goddard (the manager at the Centre for Evidence-Based Medicine in Oxford) forwarded this question to the Evidence-Based Health Care list: "Could you please tell me why EBM is important? Can a physician practice medicine without knowing EBM?" The email list has over a thousand subscribers and many had an opinion about this question. I will abbreviate these to highlight some of the threads, but you can read the full text on the list.
Bill Cayley kicked us off by saying
Here’s my answer—along the lines of the introduction I give our medical students: In medicine, we are continually making decisions, and if medicine is to be a science or a “learned” profession, we need to think critically about HOW and WHY we make those decisions. There are a number of potential approaches to making decisions: (1) Tradition (“We’ve always done it this way,” “My teachers did it this way”), (2) Convention (“Everyone else always does it this way”—ie, going with the crowd), (3) Belief or Dogma (“I believe the natural way is best”), (4) “Evidence-based”—that is based on some sort of systematic assessment of evidence.
Further, I discuss with my students the fact that you can look at evidence as simply ANY observation about the nature of the world. In the medical literature, we call a single, isolated instance of something an “anecdote” (or, if published, a “case report”). If you take a bunch of observations and group them together, we have a “case series.” You can go on up from there in terms of the rigor, systematization, and thoroughness of evidence evaluation up to the double-blinded randomized trial …
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