Evidence Based Medicine (EBM) has been defined as ” the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” by Sackett (BMJ, 1996).
Evidence Based Health care is the “conscientious use of current best evidence in making decisions about the care of individual patients or the delivery of health services.”
Current best evidence is “up-to-date information from relevant, valid research about the effects of different forms of health care, the potential for harm from exposure to particular agents, the accuracy of diagnostic tests, and the predictive power of prognostic factors.”
Those are two very long definitions, indeed!
What do they mean?
In essence, they mean that decisions regarding patient care should be informed by evidence, rather than dogma.
Why is this important?
Simply put, this is important because treatment based on
gut feeling, etc. is likely to be flawed, potentially dangerous for the patient, and often unethical.
Many hallowed medical practices have been proven to be either of doubtful benefit, or harmful to patients.
Ideally, ‘current best evidence’ should inform all patient care decisions. Sadly, that is not the case, more so in countries that need it the most.
Imagine a healthcare worker in a developing country. This could be anyone- Doctor, Nurse, etc. A choice has to be made between two treatments: One is expensive, but deemed beneficial by experts; the other is inexpensive, but not very popular.
The evidence indicates that both treatments are equally effective. However, the first treatment is chosen due to its promotion by experts. The patient pays more for treatment than necessary. In a situation wherein most healthcare expenses are out of pocket, this could mean acquiring a new debt to fund treatment costs. Even if the government is paying for the treatment, the avoidable (excess) expenditure would mean less money is available for other essential items.
The evidence indicates that the costly treatment is inferior to the inexpensive one. Again, the first treatment is chosen due to expert advice. The patient pays more to receive less effective treatment. This is clearly unethical practice, as it denies/ deprives the patient of the best available (and in this case, affordable) care. Less effective treatment translates into longer periods of sickness, greater strain on finances, greater impoverishment, etc.
Evidence Based Healthcare is not an option- it is the duty of all healthcare workers towards their patients/ communities.