ABSTRACT
Using a clinical example we discuss the reasons why some of our colleagues associate unpleasant feelings with the term Evidence-Based Medicine (EBM). We demonstrate what EBM can contribute to solve day-to-day clinical problems and discuss the six formal steps for implementation of EBM into the day-to-day practise. 1. To transform the clinical problem into an answerable 4-part question. 2. To answer this question based on your internal evidence. 3. To search for external evidence to answer this question. 4. To critically appraise the found evidence with respect to it's validity, importance and applicability. 5. To integrate the appraised external evidence into your existing internal evidence in order to come to a new decision if the additional new external evidence in convincing. 6. To assess the benefit which was gained for the patient.
Subject(s)
Evidence-Based Medicine , Otolaryngology , Attitude , Clinical Competence , Decision Making , Ethics, Medical , HumansABSTRACT
A Bavarian country doctor taking part in a course on evidence-based medicine, put the question whether there was any evidence that, in children with confirmed streptococcal infection of the respiratory tract, appropriate antibiotic treatment could reduce the risk of late complications. With the help of the German Institute for Medical Documentation and Information (DIMDI), we undertook a search of the literature, which, however, failed to turn up any information in support of a prophylactic effect of antibiotic treatment in such a case. To avoid jumping to hasty conclusions, however, the consequences that appear to suggest themselves, should be carefully considered. This example points up three major aspects of evidence-based medicine (attitude, tools and facts) that the doctor needs to acquire, and without which modern medicine will not be possible.