With all the discussion of EBM in crisis and EBM on trial it strikes me that maybe these other folks have a different definition or concept of EBM than I do. I think to have any discussion needs to come from a common ground of just what is EBM.
Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.
This is the original definition of EBM published in 1996. It urged us to strive to use best available evidence in making clinical decisions. It also cautioned not to be a slave to evidence as evidence was often not applicable to individual patients. This definition served us well until the patient-centered paradigm of care became popular and the definition of EBM evolved to its current form:
This definition is more explicit about the order of importance of the individual elements of the components of EBM: patient preferences and actions is foremost, followed by the clinical state and circumstances and the research evidence. All this is tempered or tied together by our clinical expertise. The evidence tells us what could be done while the rest tells us what should be done.
The other way to look at EBM is that it is just a set of skills:
- asking an answerable clinical question
- finding the best available evidence
- critically appraising the evidence
- applying the evidence to individual patients
- appraising how well you did on each step and, I think, appraising the impact on a patient
So from this background I find it difficult to lay blame on EBM for many of the problems with the evidence. I blogged on this previously and will refute their claims at EvidenceLive2015 in April.