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Currents |15 February 1998

Evidence-Based Medicine Gaining Supporters

Aaron Levin

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Lawrence Smith, MD, of Mount Sinai Medical Center in New York City, recalled a recent episode on morning rounds: “A consulting physician recommended antibiotics to treat a patient with pancreatitis. A resident challenged him, and the consultant quoted one recent study. The resident went to the library, reviewed the literature, and found that the study in question applied only to a more severe form of pancreatitis, not to our patient.” Backing up clinical decisions with validated information is the heart of evidence-based medicine (EBM) in the clinic, an approach gaining more adherents all the time.
“We organized an evidence-based medicine approach in our residency program 2 years ago,” Smith continued. “In morning rounds, we challenge every statement. We want to know evidence and data, not the seniority of the doctor. The students love it, and the attending physicians enjoy discussing the cases.”
Evidence-based medicine may sound redundant: Isn't all medicine based on evidence? Patients-and many physicians-might be surprised to learn how little of modern medical practice actually derives from rigorous clinical evidence. Physician and mathematician David M. Eddy, MD, PhD, was quoted in 1991 as estimating that “as few as 15% of medical decisions are based on the results of rigorous evidence,” although more recent studies have shown that a higher proportion of patients can be managed with interventions that are based on strong evidence from research (Lancet. 1995; 346:407-10).
Typically, physicians have acted largely on the basis of “clinical intuition, anecdotal evidence, personal experience, or help from authorities”-an approach...
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Levin A. Evidence-Based Medicine Gaining Supporters. Ann Intern Med. 1998;128:334–336. doi: 10.7326/0003-4819-128-4-199802150-00057

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Published: Ann Intern Med. 1998;128(4):334-336.

DOI: 10.7326/0003-4819-128-4-199802150-00057

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