Dear paul
The ebm discussion reminded me that our paper had gone cold on how can I
show I am an evidence based practitioner. Are you still interested in
it. When are you moving back to queensland
bruce
-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Paul Glasziou
Sent: Saturday, 13 March 2010 9:08 a.m.
To: [log in to unmask]
Subject: Re: What does EBM behaviour look like in real life clinical
practice?
Dear Maartje
You are exactly right that "EBM" is a a desirable aim but without the
"how to" specified. Dave Sackett used the "evidence cart" on ward
rounds here in Oxford (Details are in: Finding and applying evidence
during clinical rounds: the "evidence cart". Sackett DL, Straus SE.
JAMA. 1998 Oct 21;280(15):1336-8. ). But that will not work for
everyone. In one of our interviews about doing EBM, Ian Scott describes
trying the evidence cart but switched to an "educational prescription"
approach. I suspect different approaches will suite different
specialities and circumstances. In the 5 interviews we have up on the
CEBM website, the folk (Hywel Williams, Ian Scott, Bob Phillips, Yaser
Faden, and Per Vandvik) describe quite different approaches (though PICO
questions leading to team journal clubs are a common theme).
http://www.cebm.net/index.aspx?o=4648
We should have a few more interviews up in the next 2 weeks, but they
illustrate further diversity of successful EBM behaviours.
So I suppose EBM is a goal but there may be many ways & behaviours
needed to acheive it.
On the question of the right balance between clinical expertise and
using evidence, I would say I want lots of both! I often ask folk if
they were ill, whether they would want Osler (wtih 1900 knowledge but
great expertise) or a 2010 specialist trainee. Most opt for the latter,
but ideally we'd like an up-to-date Osler!
Good luck
Paul Glasziou
Swennen, M.H.J. wrote:
> Dear all,
>
> My name is Maartje Swennen and I am a PhD student at the University
> Medical Centre Utrecht in The Netherlands.
>
> Could anyone help me to translate the theoretical definition of EBM
> (e.g. Sackett, Guyatt) into the (diverse!) ways of how doctors
> interpret EBM and do (not) apply evidence in routine clinical
practice?
>
> For example, a doctor could prefer to answer his/her clinical
> questions by means of guidelines/protocols, or Pubmed (original
> articles or reviews), or by asking a colleague, or by reading a book
> about it, or a trial and error approach, or ......
>
> When do we actually speak of EBM-behaviour?
> For example, what is the right balance between using clinical
> expertise and using evidence?
> It is difficult to ask doctors if they follow the five steps, because
> depending on the frequency of the problem at hand and depending on
> their interpretations and preferences they will do only a part of the
> five steps. Sometimes that is good enough, sometimes it is not.
>
> Is there a threshold we could use to judge the EBM behaviour as good
> enough in routine clinical practice?
>
> Moreover, could we capture this into one or more multiple choice
> questions?
>
> The more I try to capture EBM behaviour the more difficult it seems to
> get! Can anyone be of help in this?
>
> Many thanks!
> Kind regards, Maartje Swennen
>
------------------------------------------------------------------------
>
> /De informatie opgenomen in dit bericht kan vertrouwelijk zijn en is
> uitsluitend bestemd voor de geadresseerde. Indien u dit bericht
> onterecht ontvangt, wordt u verzocht de inhoud niet te gebruiken en de
> afzender direct te informeren door het bericht te retourneren. Het
> Universitair Medisch Centrum Utrecht is een publiekrechtelijke
> rechtspersoon in de zin van de W.H.W. (Wet Hoger Onderwijs en
> Wetenschappelijk Onderzoek) en staat geregistreerd bij de Kamer van
> Koophandel voor Midden-Nederland onder nr. 30244197. /
>
> / Denk s.v.p aan het milieu voor u deze e-mail afdrukt. /
>
>
------------------------------------------------------------------------
>
> /This message may contain confidential information and is intended
> exclusively for the addressee. If you receive this message
> unintentionally, please do not use the contents but notify the sender
> immediately by return e-mail. University Medical Center Utrecht is a
> legal person by public law and is registered at the Chamber of
> Commerce for Midden-Nederland under no. 30244197. /
>
> / Please consider the environment before printing this e-mail. /
>
|