Ethics and evidence based surgery.
Traditionally, surgical practice has been experiential and based on the contemporary understanding of basic mechanisms of disease. It was both a science and an art and depended to far too great an extent on the individualism and self belief of its main exponents. "Evidence based medicine" (EBM) emerged in the 1980s and a new gospel of "Rules of Evidence" was introduced. There is no doubt that the net effect of EBM has been beneficial, but over reliance on randomised controlled trials and the lack of generalisability of scientific evidence to individual patients has perhaps led to less enthusiasm for its tenets among surgeons. There are valid and spurious reasons for this that are discussed. The situation is improving but inevitable tensions remain between the surgeon committed to the individual patient here and now, and the clinical researcher whose focus is the benefit of future patients in the larger community.
Stirrat
G M
GM
University of Bristol, Bristol, UK. gstirrat@blueyonder.co.uk
D001291:Attitude of Health Personnel; D004992:Ethics, Medical; D019317:Evidence-Based Medicine / Q000941:ethics*; D006801:Humans; D010817:Physician-Patient Relations / Q000941:ethics; D017410:Practice Guidelines as Topic; D011361:Professional Competence; D011364:Professional Practice / Q000941:ethics; D011787:Quality of Health Care / Q000941:ethics; D016032:Randomized Controlled Trials as Topic / Q000941:ethics; D012107:Research Design / Q000592:standards; D013514:Surgical Procedures, Operative / Q000941:ethics* / Q000379:methods; D016896:Treatment Outcome