Evidence Based Medicine (EBM) is a relatively new concept in the developing countries but it plays a pivotal role in developed countries. For over 2000 years now, two principles have formed the basis of medical practice: “primum non nocere” (first do no harm) and “succurrere” (do good). EBM is the process of systematically reviewing, appraising and using clinical research findings to aid the delivery of optimum clinical care to patients. It all started in 1972 when Professor Archie published his book ‘Effectiveness and Efficiency: Random Reflection on Health Services.’
Developing countries have a shoestring health budget and doctors have to work under very tight limitations. The basic principle of EBM – that we should treat where there is evidence of benefit and not treat where there is evidence of no benefit (or harm). It is ideal for developing countries and their tight budgets.
Here’s the EBM method:
Asses your patients->Ask Clinical Questions->Acquire the Best Evidence-> Appraise the evidence -> Apply evidence to patient care.
If you aspire to be a top notch doctor or remain one, you need to stay on top of new developments as they occur. Evidence Based Medicine provides you with the tools you need to find important new medical research quickly and easily, and to work out its connotations for your practice. For example, MEDLINE and its rich resources at your fingertips.
A detailed and exact knowledge of the outcomes of different treatments, derived from the research, can often save lives. For example, consider the problem of whether to perform an endarterectomy on a newly symptomatic patient with severe carotid stenosis. The benefit of surgery in reducing the risk of a major stroke or fatality is summed up in the following paragraph (L. Goldstein et al, 1995):
Percentage of Patients with Stroke or Fatality:
Surgery Group: 10%
No Surgery: 19%
Number needed to Treat: 11
This means that you need only treat 11 patients, on average, to prevent a major stroke or fatality – a clear and very substantial benefit. However, 47% of primary care physicians and internists won’t recommend it just highlighting the lack of familiarity with up to date medical literature.
Since EBM first emerged as a coherent approach to appraising treatment options, we have seen its adoption, alongside health economics, as the gold standard tool for commissioning and provision of health services in developed countries. It is being applied to many aspects of healthcare now from surgical interventions to pharmaceutical treatments.
Additionally, online and quick to resources and integration with medical information technology (IT) systems means that doctors are now, more than ever, in a position to implement evidence at
the point of contact with individual patients, ensuring that evidence is translated into
Perhaps the area where work remains to be done is in the effective communication of the EBM message to patients. There is still a perception – often fuelled by an ill-informed media and traditional doctors that EBM is basically applied solely for financial reasons. This might be the reason sometimes but it does provide a focused and less harmful healthcare to patients.
The dire state of healthcare in developing countries and with no improvement in sight…it is imperative to introduce EBM. It’s not easy but it is conceivable. Better Healthcare. Economically Viable. I believe it’s definitely the way to go.
About the author: Mohammad Adil Islam is a medical student from Rashid Latif Medical College, Lahore, Pakistan. He has interest in the Evidence Based Medicine. He can be reached at: [email protected]
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