title: [Criticism of evidence-based medicine: from reductionism to realism in the application of guidelines].
abstract: This article discusses recent criticism of evidence-based medicine (EBM), which has tended to place unilateral emphasis on evidence originating from randomised trials into effectiveness. The goal of the pioneers of EBM, however, was actually the application of scientific evidence to the individual patient, including the doctor's experience ('practice-based') and the patient's preference ('preference-based') in decision making. Guidelines can support this process by systematically paying attention to patients' preferences and by presenting the advantages and disadvantages of different management options. The application of guidelines should not involve pursuit of 'standard care' but, primarily, the pursuit of shared decision making. This could lead to 'real EBM', in which medical knowledge is translated to practical choice options from different perspectives.
authors: Nederlands Huisartsen Genootschap, Utrecht.
authors: Jako S
authors: JS
authors: Burgers
mesh_terms: D003657:Decision Making; D019317:Evidence-Based Medicine; D006801:Humans; D057240:Patient Preference; D010820:Physicians; D017410:Practice Guidelines as Topic