Evidence Based Medicine: Basic Principles Of Practice

Abstract

Introduction 

Evidence based medicine (EBM) revolves around three interrelated factors namely: Clinical expertise, best research evidence and patients' values as well as preferences (see Figure 1). It has been defined as:

"The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patient"

EBM necessarily recognizes the long acquired expertise of individual clinician or even a community of practitioners, the value of systematic research as the conduit for best evidence as well as other often overlooked factors such as patients' legitimate concerns, values, fears and preferences. Integrating these factors in a timely and contextual way has been the hallmark of the practice of EBM. In the context of one-on-one patient care, this understanding of EBM has been aptly summarized as the application of the evidence "to the right patient, at the right time, in the right place, at the right dose, and using the right resources." However, EBM can be extended to include a wide range of evidence based decision processes involving global and national health systems, health management, health policy as well as legislation sometimes with direct impact on public health. In this circumstance, Evidence Based Health Care (EBHC) would be a more appropriate term. To the extent that EBM seeks the integration of clinical expertise usually acquired overtime through training with systematic research and patients' legitimate preferences, it promotes critical thinking, open-mindedness and the courage to discard what has proven to be ineffective or frankly harmful.