The misuse and misunderstanding—even by health-care professionals—of the term evidence-based medicine (EBM) is rampant. This improper usage is out of control and something needs to be done to prevent these words (and this concept) from becoming another medical cliché. To correct the misperception surrounding the concept of EBM, we should determine the precise meaning of the term and then ask ourselves the real questions: Are we truly evidence-based medical practitioners? Why?
Throughout the years, I have witnessed many clinicians claim to be dedicated EBM practitioners when in reality, in most instances they are imparting nothing more than personal biases or mere anecdotes being passed off as EBM principles.
Case in point: Acute exacerbations of chronic obstructive pulmonary disease (COPD) call for the use of systemic corticosteroids. That treatment regimen may not be in contention, but the route of corticosteroid administration was always debated even though the established and recommended preferred route in the literature was oral instead of high parenteral doses. I have often heard providers express their preference for the parenteral route as being more effective than the oral route based on their “real-world experience,” despite being aware of the scientific evidence. These shared experiences or seasoned opinions may not be so bad, but may well be inferior to and not nearly as robust as the true tenets of evidence-based medicine, and the semantic transgression is troubling.
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Why, in my opinion, are we not practicing genuine EBM? It’s usually not because of lack of awareness of the information presented in the medical literature, nor because of malicious intent or incompetence. Rather, it is often “conflicts of interest” or clinical biases that stand in the way of implementing EBM—inherent systems-based factors that divert our attention and best-intentioned actions away from these sound, validated clinical practices. Examples of such factors include restrictive employer or reimbursement policies, or the need to practice defensive medicine. The end result of our clinical decisions might not be as black-and-white as we think, especially if we are forced to forgo a specific diagnostic treatment and/or scramble for a less effective alternative due to insurance-related pressures.
How can we improve and challenge ourselves? First, we must truly understand EBM. One of the most frequently cited definitions comes from Dr. David L. Sackett and colleagues, who described EBM as “the conscientious, explicit and judicious use of current best evidence when making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from sound credible systematic research.”
It’s time to restrict—if not discard entirely—the “loose” usage of this term so as not to confuse our patient communities or come across as disingenuous caregivers.
The topic and usage of the term EBM should be employed measurably and meaningfully since it matters most to those on the receiving end of health care—the patients. Because we pride ourselves on delivering patient-centered care, we must familiarize ourselves with the research and best practices promoted by EBM while taking care to use these approaches wisely and appropriately. Only then can we say that we are truly EBM practitioners.
