Agree Bill.
We ask people to first describe their (or an) ethical framework for
decision making. Hopefully we get to something like this:-
First do no harm (Safety) - well done Hippocrates, but what next?
Try and do good - efficacy and effectiveness
Justice / Equity - most health care practioners and especially students
have an inner drive for fairness, and it's entirely legitimate therefore
to consider benefits:cost from a population perspective as well as the
health care needs of individuals (I know we all know this)
Patient autonomy (it's called assualting patients if you don't ask the
patient and respect their wishes).
So what sort of evidence would you expect people to use to populate
these four ethical domains and then weight them up when decision making?
Obviously we could just do what others told us or what we've always done
or what we intuitively believe. But PATIENTS Have the right to expect us
to use the best evidence that's available to help them etc etc a le
Bill. We are here to serve our patients and we therefore need to strive
to avoid falling into the traps of the cognitive biases e.g. of
believing what we see, or have done before and think works, or what
others tell us, or indeed of basing our practice on pathophysiological
mechanisms where better evidence exists. Further we must resist the
attempts of those who would seek to exploit our cognitive biases (human
frailty) - bearing in mind that we all suffer from biases induced by our
own values.
Then it gets tricky. What approaches can be used to make decisions
(weigh up the values of the four domains)? This is in my experience best
debated over a very good dinner (with a decent bottle of wine for those
who wish!)
Best wishes
Neal
Neal Maskrey. Medical Director, National Prescribing Centre, 70 Pembroke
Place, Liverpool L69 3GF. Tel: 0151 794 8135. e-mail:
[log in to unmask]
-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Bill Cayley,
Jr
Sent: 30 June 2006 14:26
To: [log in to unmask]
Subject: Why is EBM Important?
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 or the meta-analysis.
ALL observations can be considered "evidence" - it's just a matter of
asking what the QUALITY of your evidence is.
So, I see evidence-based medicine as the effort to critically examine
the reasons we do what we do, and the information or evidence that
supports it. In one sense, ALL medicine is "Evidence-Based Medicine" -
it's just that if you practice medicine without thinking critically
about what you do and without looking for high-quality evidence (or at
least the highest quality available) then you are practice medicine
based on very LOW-quality evidence.
Bill C
--- Olive Goddard <[log in to unmask]>
wrote:
> Dear Colleagues,
>
> Here's a question some of you might like to respond to.
>
> All good wishes,
>
> Olive
>
> >>> "Gang Jiang" <[log in to unmask]>
> 29/06/2006 16:16 >>>
>
> Dear Sir/Madam:
>
> I am very interested in evidence based medicine.
> Could you please tell
> me why EBM is important? Can a physician practise medicine without
> knowing EBM?
>
>
> Thank you,
>
> Gang Jiang
>
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Bill Cayley, Jr, MD MDiv [log in to unmask]
Augusta Family Medicine Home Address
207 W Lincoln 3433 McIvor St
Augusta, WI 54722 Eau Claire, WI 54701
Work: 715-286-2270 Home: 715-830-0932
Page: 715-838-7940 Cell: 715-828-4636
