The practice of evidence-based medicine starts with asking the right question. This question should take into account the patient being treated, the intervention being pursued, a comparison with the alternative, and the outcome to be expected, shortened to the acronym PICO.
However, this is just one step in providing treatment. After the question has been formed, the physician needs to find supporting evidence, evaluate the information found, and apply that evaluation into a course of treatment. Then, once the course of treatment has concluded, it is necessary to determine how successful it was.
Researching the question
In a field as old as medicine, the amount of literature on a given situation can be extensive. There are national journals and databases on a great number of subjects, available to be searched.
Keywords related to the question at hand can be entered into databases like PubMed, MEDLINE, EMBASE, or Cochrane. Cochrane in particular is valuable for finding the abstracts and results of trials, and is updated quarterly. For faster searching, Boolean operators like “and” and “or” can be used to more closely align the results with the patient being analyzed. These techniques can also be used to verify the quality of the information returned.
Judging the evidence
While each situation has its own details, the better the evidence can be correlated with the patient at hand, the more valuable it is as support. The nature of the studies matters as well: The best ones are peer-reviewed and corroborated by cohort studies. If a particular claim seems outlandish, or particular data points seem like massive outliers, it is up to the investigating doctor to use experience and good judgment in applying those results.The presence of research into a given subject is not necessarily an indicator of quality. To be of value, data must be valid, applicable, and relevant.
Applying what has been learned
Not all research is applicable to a given situation, even if it is valid otherwise. In some situations, a course of treatment could be effective, but is impractical logistically. For example, it could require a piece of equipment that the hospital does not have access to, or could be prohibitively expensive. Or, it may have been successful in a research setting, but there is a lack of evidence for it working in a patient-provider environment.
This circumstance is one where the experience and the critical thinking skills of the physician become paramount. All available evidence should be weighed against experience and personal history to help come to an informed conclusion. All treatment, regardless of how valid it is, should conform to the patient’s wishes.
Evaluating the success of the treatment
The role of the provider does not end with the cessation of treatment. After the care has been given, a doctor should determine how successful it ultimately was, and how similar the results are to what was expected going into the process. In some cases, this means sharing this feedback with databases, so that future physicians can learn from the lessons it suggests.
Between a full patient load and ever-present paperwork, it can be hard to find the time to stay current on all medical guidelines, let alone provide information for other physicians to learn from. However, the process of adding to the body of evidence for a particular treatment allows for other doctors to continue making sound decisions based on critical thinking. The more thoroughly providers undergo this process, the higher standard of care all patients will receive.
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