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Link: Ad libitum.

Resistance to Evidence-Based Medicine Lately I have been encountering (or noticing more) a reluctance on the part of many physicians to accepting that evidence based medicine is a good thing. Theres quite a bit written about this. Physicians are resistant to accepting EBM for several reasons: 1. Many feel threatened that with EBM they will not be allowed to practice the way they want to practice - most physicians have a strong sense of autonomy. 2. They may feel that EBM is a tool that others will use to enforce 'recipes' on how to practice medicine (the "It's cookbook medicine" argument). 3. Some feel that each patient encounter is unique and only the physician is able to judge in that particular context what the best treatment is for his patient. 4. Many docs are unfamiliar with the concepts and skills required to practice EBM. This leads to fear of the unknown, which is one of the strongest fears anyone can have. 5. Misconceptions about the nature of EBM are common. 6. Most physicians do not have the time to devote to searching and appraising the literature. 7. Patients do not demand that their doctor practices according the evidence and not just based on opinion, habit or out-dated information. 8. The "medicine is an art, not a science" argument.

# posted by LMF @ 11:39 PM 0 comments
Monday, June 20, 2005

Essential Tools for EBM
I had previously listed two essential tools to practice evidence based medicine:
1. A healthy sense of skepticism.
2. An understanding of the concept of probability.

Here are some more:
3. A belief that systematic observation yields the truth more reliably than unsystematic, anecdotal observation.
4. An ability to deal with, and live with uncertainty.
5. A willingness to accept that the current basis for your practice may be false.
6. Acceptance that given the same medical facts, the appropriate decision may vary, depending on how the patient values different outcomes.
7. Willingness to question authority. Experts (even renowned ones) may be wrong.
8. Honesty with oneself about one's own biases.

A couple of good posts from a MD blog that is dedicated to EBM with a slant towards pediatrics and neonatology. has a few good jokes as well!

Larry

Comments

[Michael DuPriest]

One comment in particular hit home. To practice EBM one must make time to read. This sounds straight forward, but after a long day at the office I not that motivated to go home and work again. This becomes even more true when time is needed to devote to family and other interests.

Last year I read a book titled, " Making Room for Life." It was then that I began to formulate a plan on how to bring balance to my life. One area was my inability to keep abreast of the literature. Thus, I decided that I needed to take time from patient care to devote to practice development. Not from the sense of more patients, but how to become better at what I do.

I feel that one should have core diagnostic skills, EBM approaches, and armed with non-evidenced fringe approaches. I like to practice in that order. Some may look on the latter, non-EBM fringe, as not a consideration. I one time so did I. But these approaches repeated come back and get me out of clinical condundrums.

So this fall I will not see patients on Wednesday afternoon. I will devote this time to reading, contemplation, and the gradual integration of this evidence into my practice.

Michael DuPriest DC PT OCS DABCO

[Rob Wainner]

Michael,

Great points and a reminder that keeping up to date is a "contact sport" that requires us to overcome interia and balance priorities. It is also a good reminder that pre-processed sources of evidence are a must in this day and age of information overflow. Finally, "lack of evidence" doesn't mean "evidence against". There are no doubt many interventions helpful for selected patients with various conditions, the effects of which have yet to be elucidated with clinical research. The main caveat when applying interventions lacking evidence is to retain a healthy dose of skepticism and a willingness to change when pertinent evidence does become available.

Rob Wainner