Evidence-Based Medicine

Next, the magnitude of the results and its significance are evaluated. Finally,
one should look to the applicability of these results to his/her patients.
Questions asked in this process include:
a) Is the outcome of the study a «patient oriented evidence that matters»
(POEM) or a «disease oriented evidence» (DOE)
b) Does the study population correspond to your practice population
c) What method is described to answer the research question
d) How will this study impact on your practice
Applying the evidence to individual patient care
EBM will modify individual patient care, leading to the use of proven therapies
and diagnostic tests only where data exists to support their use, to the
withdrawal of those which are unproven, and to closer scrutiny of those for
which clear evidence for continued use is lacking. As physicians become more
aware, patients become better educated and a more equitable physicianpatient
relationship follows.
Evaluating the process
A periodic review of the process will show how well a clinical question has
been answered and advise as to its replicability either in the same or another
setting. The more EBM is used, the more the challenges to the practitioner and
the more the experience gained.
The Logic Behind EBM
To make EBM more acceptable to clinicians and to encourage its use, it is best to turn a
specified problem into answerable questions by examining the following issues:
• Person or population in question.
• Intervention given.
• Comparison (if appropriate).
• Outcomes considered.
For example: Is an elderly man given nicotine patches more likely to stop
smoking than a similar man who is not
Next, it is necessary to refine the problem into explicit questions and then
check to see whether the evidence exists. But where can we find the information
to help us make better decisions
-22-