Evidence-based medicine (EBM) is the conscientious, explicit and judicious use of current best medical evidence in making decisions about strategies to promote the health of individuals, communities, and populations. The practice of EBM means integrating local expertise with the best available external evidence yielded by systematic research.
EBM requires conducting cross-disciplinary literature searches, applying rules of evidence and appraisal of study quality, and selecting the most effective programs.
EBM asks the practitioner to present to the patient a reliable summary of the area, including its strengths, weaknesses, and recommendations.
In practice, physicians contextualize the best available research evidence, integrating it with their individual clinical expertise and their patients’ values and expectations. However, the incorporation of patient values and clinical expertise in EBM only partly recognizes the fact that many aspects of health care depend on individual factors. These aspects include variations in individual physiology, pathology, and quality- and value-of-life judgments. These more personal factors are only partially subjected to scientific inquiry and sometimes cannot be assessed in controlled experimental settings.
Practical application of available evidence is therefore dependent on patient circumstances and preferences; it remains subject to input from personal, political, philosophical, religious, ethical, economic, and aesthetic values. This has led to a shift from the original term “evidence-based medicine” to “evidence-informed healthcare”, to better emphasize that some decisions need not necessarily be based or comply with the evidence.
The primary care physician is faced with the current challenge of keeping up with the ever-changing needs of his or her patients while monitoring this shift in the application medical studies as they effect best practice standards. EBM will continue to evolve and bridge the gap between research and practice, applying (evidence) to clinical practice while emphasizing the importance of quantitative (as well as qualitative) evidence in the “art” of clinical decision-making. It aims to make decision making more structured and objective by better reflecting the evidence from research. By introducing the use of research information in clinical decision making, particularly from clinical epidemiology, EBM has driven a transformation of clinical practice and medical education.