Taking stock of evidence-based medicine: opportunities for its continuing evolution.
Tough but constructive criticisms of evidence-based medicine (EBM) have without doubt informed the evolution and serial reconstitutions of this approach to clinical decision making and behaviour. Yet, concerns about EBM persist and as EBM changes in response to reflection and criticism, so too do the criticisms themselves. This paper describes our current understanding of EBM and, to identify opportunities for the continuing evolution of EBM, discusses some key attributes of EBM that still or now cause us concern. Specifically, these attributes are the nature of evidence in EBM; the unknown effectiveness of EBM; the clinician-centric focus of EBM; and the potential of EBM to harm patients.
Buetow
Stephen
S
Department of General Practice and Primary Health Care, University of Auckland, Private Bag, Auckland, New Zealand. s.buetow@auckland.ac.nz
Upshur
Ross
R
Miles
Andrew
A
Loughlin
Michael
M
D003657:Decision Making; D034462:Dissent and Disputes; D036262:Empirical Research; D019317:Evidence-Based Medicine / Q000379:methods / Q000592:standards*; D006801:Humans; D018802:Patient-Centered Care; D010506:Periodicals as Topic; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome