Evidence-based psychiatry.
OBJECTIVE
To apply the evidence-based medicine paradigm to the domain of psychiatric practice and to bring out the consequences for psychiatry of this approach in order to foster the emergence of an evidence-based psychiatry.


METHODS
The basic assumptions of traditional and evidence-based paradigms, as delineated by the Evidence-Based Working Group, are used to structure an exploration of the evidence-based approach to psychiatry. Theoretical and practical issues are considered and an example of evidence-based decision making is given.


RESULTS
An evidence-based approach to psychiatry is described as one that emphasizes the importance of systematic observation and the use of rules of evidence in hypothesis testing. It is suggested that psychiatrists using this approach will be in a position to provide superior patient care.


CONCLUSIONS
The application of scientific method to psychiatric problems is discussed as the essence of an evidence-based approach. The common error of "scientism" is described. The authors identify advantages and limitations of an evidence-based approach to psychiatric practice and advocate a decision-making process that balances individualized clinical acumen (phronesis) and information derived from empirical study of groups of patients (techne).
Goldner
E M
EM
Department of Psychiatry, University of British Columbia, Vancouver.
Bilsker
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D002170:Canada; D018849:Controlled Clinical Trials as Topic; D006801:Humans; D016239:MEDLINE; D001523:Mental Disorders / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D010347:Patient Care Planning / Q000639:trends; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011570:Psychiatry / Q000639:trends*; D011785:Quality Assurance, Health Care / Q000639:trends*; D012106:Research; D012586:Science