Sorry,
What is a CAM provider?
Mike Bennett
>As an CAM provider who practices EBM in spinal manipulation I have few if
>any peers. CAM providers are not aware of EBM/guides and if they were it
>appears from these posts they would not follow them anyway. Any thoughts as
>to bringing EBM/guides to CAM providers?
>--
>Preston H. Long DC
>
>> From: "Sontheimer, Daniel MD" <[log in to unmask]>
>> Reply-To: "Sontheimer, Daniel MD" <[log in to unmask]>
>> Date: Sat, 13 Jan 2001 10:15:17 -0500
>> To: [log in to unmask]
>> Subject: Re: demise
>>
>> Thanks, I have enjoyed your work Family practice and BMJ. I hope we can
>> move EBM towards an implementation and practice level, instead of the
>> current trend I call "appraisal for appraisal's sake", that gives little
>> regard to utility and applicability.
>> Keep thinking!
>> Best Regards,
>> Dan Sontheimer
>> Assoc. Director
>> Spartanburg Family Medicine Residency
>> Spartanburg, SC USA
>>
>>> -----Original Message-----
>>> From: Toby Lipman [SMTP:[log in to unmask]]
>>> Sent: Saturday, January 13, 2001 5:35 AM
>>> To: Sontheimer, Daniel MD
>>> Cc: [log in to unmask]
>>> Subject: Re: demise
>>>
>>> In message <CF1AA81579F2D211B64600805FFE91E102383C32@prc23nts>,
>>> Sontheimer, Daniel MD <[log in to unmask]> writes
>>>> Agreed, I think EBM next phase is to grow to a level, where it is used
as
>>> a
>>>> lens/filter with which to guide the practice of Medicine.
>>>> Combining the work of EBM with reflective practice (clinical jazz in
>>>> Slawson's and Shaughnessy's work), can help move us forward.
>>>>
>>>> The biggest problem with EBM is the attempts to represent "the truth",
as
>>>> being solelly defined by EBM. Thus, you now have drug reps, and other
>>>> soliciters approaching everything with "evidence-based" perspective.
>>>>
>>>> Perhaps there is a more post-modern perpsective for EBM, I think it
is
>>> in
>>>> combining with reflective practice, and then we can avoid this bouncing
>>>> around of "the truth"
>>>> Dan
>>>>
>>>>
>>> You are right. I think the first phase of EBM was the working out of how
>>> research findings could be applied to clinical practice using
>>> epidemiological principle, and the realisation that clinicians had both
>>> the right and duty to question established practice.
>>>
>>> It has now (in the UK at any rate) been largely hi-jacked by expert
>>> groups who have adopted it as a sort of mantra to justify and give more
>>> weight to decisions they would have made anyway (see the recent
>>> controversy in the BMJ and rapid responses about the National Institute
>>> of Clinical Excellence (NICE)).
>>>
>>> While there is a minority grassroots movement that is attempting to
>>> encourage evidence-based practice by coal-face clinicians and managers
>>> (such as, for example, through the London, Oxford and our own Durham
>>> workshops) there is not nuch widespread support at senior levels for
>>> ordinary clinicians to acquire these skills - they would rather keep
>>> them to themselves (although as the NICE imbroglio shows, not
>>> necessarily with any great degree of competence). This may well be
>>> because senior clinicians and managers, in their hearts, don't really
>>> want more junior people to be able to make their own decisions according
>>> to the evidence and their patients' needs, because it threatens the
>>> establishment's power and influence (see Lipman, T. Power and influence
>>> in clinical effectiveness and evidence-based medicine. Family Practice
>>> 2000;17:557-563).
>>>
>>> The other major issue is: once you have learned the skills of EBM, how
>>> do you actually use it in clinical practice? Some work has been done on
>>> ways of accessing evidence quickly in the clinical setting (eg the
>>> 'evidence cart' work). Most UK GPs now have internet access at their
>>> desks and some are beginning to make tentative experiments on including
>>> the EBM process within the context of routine consultations. It is
>>> becoming clear to me that this is a huge field for research, and that
>>> EBM has to be integrated into an already sophisticated consultation
>>> process rather than replace it with something quite different.
>>>
>>> So we need to ask: is it feasible? how much time do we need? what
>>> prompts us to ask questions and do searches, given that we are never
>>> going to have the time (nor do we need) to do this in every case? how do
>>> we involve the patient in this process? how do we judge the extent to
>>> which patients want to share decision making? do common scenarios such
>>> as sore throats (in which we will soon know the evidence by heart!) lead
>>> us to develop "EBM scripts", in which the scenario is learnt and acted
>>> out repeatedly?
>>>
>>> And so on.
>>>
>>> So I think we are beginning to understand that learning the basics of
>>> EBM is only the beginning and that we are entering upon a time in which
>>> we have to discover the way it can be used and what impact it will have
>>> upon practice. Maybe that is why we haven't been so vocal recently - we
>>> are thinking!
>>>
>>> Toby
>>> --
>>> Toby Lipman
>>> General practitioner, Newcastle upon Tyne
>>> Northern and Yorkshire research training fellow
>>>
>>> Tel 0191-2811060 (home), 0191-2437000 (surgery)
>>>
>>> Northern and Yorkshire Evidence-Based Practice Workshops
>>>
>>> http://www.eb-practice.fsnet.co.uk/
>
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