[Factual surgery or surgery founded on facts].
In the late 90s, teachers at McMaster's university (Canada) decided to export in clinical practice a teaching concept they had developed which included, among other concepts, a critical analysis of the medical literature. "Evidence-Based Medicine" (EBM) has since been adopted by many medical specialities or physicians as a reference in their practice of medicine. However, evidence-based medicine in its definition had three legs. Critical analysis of medical literature is the most known. The analysis is based on methodological principles that have been developed by statisticians and epidemiologists, principles which are not very familiar to surgeons. The other two legs are less known, but are important. The patient is still in the very middle of the EBM's principles. It is for him, the patient with his demands, that the physician must find a solution that may be not available in the literature. The surgeon, the third leg of the system, must be involved; he must listen to the patient, understand his particular demands, and find, for him the best answers to the question asked by the patient. It is the surgeon's responsibility to be the interface between science and one individual patient. Evidence-based medicine is a new model of the relationship between patients and physicians.
Dumontier
C
C
Laboratoire d'éthique-médicale, faculté de médecine Necker, Institut de la main, Hôpital Saint-Antoine, Paris, France. christian.dumontier@sat.ap-hop-paris.fr
D019317:Evidence-Based Medicine; D006225:Hand / Q000601:surgery*; D006801:Humans; D013514:Surgical Procedures, Operative / Q000379:methods*