Does evidence based medicine adversely affect clinical judgment?

Accad, Michel; Francis, Dárrel P.

doi:10.1136/bmj.k2799

Cited by 25 publications

(7 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The advantages of this approach are obvious: evidence-based practice allows us to search the best available treatment for our patients, to optimise the decisions through our clinical judgement, generate and demand continuous investigation, confer protection against lawsuits, and base decisions on substantiated scientific data 29 . However, a number of limitations have been pointed out: evidence-based practice may denigrate clinical judgment, it does not apply to care of individual patients, advocates a slavish, "cook-book" approach to treatment, ignores patient's values and preferences, and requires solid data to make decisions; therefore, if there is no data, no recommendations can be given 29,30 . Another approach is the management by the so-called integrated healthcare processes.…”

Section: The Generation Of Clinical Practice Guidelines Showing Recommendations For Clinical Practicementioning

confidence: 99%

Clinical Audits in Chronic Obstructive Pulmonary Disease: what for?

Lόpez-Campos¹,

Arranz²,

Hernández³

2021

BRN

View full text Add to dashboard Cite

The complexity of healthcare and the rapid and constant changes in technology and therapies for chronic obstructive pulmonary disease (COPD) may generate uncertainty in decision-making and variability in clinical practice. Currently, there is a gap between the medical care that patients receive and the recommended practice. In both primary and secondary care, there are unjustified variations in practice and outcomes, which cannot be explained by the characteristics of the patients. Clinical audits emerge as an overarching tool that allows a constantly updating process that feeds back with the aim of improving healthcare. The objective of this review is to update the clinical audits for COPD as an available tool with a potential to improve healthcare. Clinicians and health managers should work hand in hand to overcome current limitations and be able to give the best possible clinical care for patients with COPD. (BRN Rev. 2019;5(2):120-134)

show abstract

Section: The Generation Of Clinical Practice Guidelines Showing Recommendations For Clinical Practicementioning

confidence: 99%

Clinical Audits in Chronic Obstructive Pulmonary Disease: what for?

Lόpez-Campos¹,

Arranz²,

Hernández³

2021

BRN

View full text Add to dashboard Cite

show abstract

“…If EBM is the “…judicious use of …evidence” 3 , it is implied that a form of judgment is necessary 47 . For this reason we must be able to critically evaluate the available literature and must teach our students and junior doctors to do the same.…”

Section: The Proposalmentioning

confidence: 99%

The Emperor's New Clothes: a Critical Appraisal of Evidence-based Medicine

Tebala

2018

Int. J. Med. Sci.

View full text Add to dashboard Cite

Evidence-Based Medicine (EBM) is the way we are expected to deliver our healthcare in the 21st century. It has been described as the integration of information from best available evidence with the doctor's experience and the patient's point of view. Unfortunately, the original meaning of EBM has been lost and the worldwide medical community has shifted the paradigm to Guidelines-Based Medicine, that has displaced the figures of the doctor and the patient from the decision-making process and relegated them to mere executor and final target of decisions taken by someone else. Problems related to the reliability of evidence and to the way guidelines are constructed, implemented and followed are discussed in detail. It is mandatory that the whole medical community takes responsibility and tries to reverse this apparently inexorable process so to re-establish a proper evidence-based care, where patients and their healing relation with practitioners are at the centre and where doctors are able to critically evaluate the available evidence and use it in light of their personal experience and knowledge.

show abstract

“…However, the likelihood of being responsive toward a regimen of each individual patient with distinctive demographics and phenotypes is often more needed by a physician in the clinical situation (11)(12)(13). There are continuous concerns on the conventional evidence-based paradigm building on meta-analyses and randomized controlled trials with limited personalized design (e.g., prespecified subgroup analysis, responder analysis), such as being over-concentrated in population-based assessment (14,15), over-standardized treatment (15,16), and lacking personalization (17). This affected the clinical utility of the evidence (18) and was contradicted with many core principles of TCIM.…”

Section: Introductionmentioning

confidence: 99%

PRAgmatic Clinical Trial Design of Integrative MediCinE (PRACTICE): A Focus Group Series and Systematic Review on Trials of Diabetes and Kidney Disease

et al. 2021

View full text Add to dashboard Cite

Background: Pragmatic trials inform clinical decision with better generalizability and can bridge different streams of medicine. This study collated the expectations regarding pragmatic trial design of integrative medicine (IM) for diabetes and kidney diseases among patients and physicians. Dissonance between users' perspective and existing pragmatic trial design was identified. The association between risk of bias and pragmatism of study design was assessed.Method: A 10-group semi-structured focus group interview series [21 patients, 14 conventional medicine (ConM) and 15 Chinese medicine (CM) physicians] were purposively sampled from private and public clinics in Hong Kong. Perspectives were qualitatively analyzed by constant comparative method. A systematic search of four databases was performed to identify existing IM pragmatic clinical trials in diabetes or kidney disease. Primary outcomes were the pragmatism, risk of bias, and rationale of the study design. Risk of bias and pragmatism were assessed based on Cochrane risk-of-bias tool and PRECIS-2, respectively. The correlation between risk of bias and pragmatism was assessed by regression models with sensitivity analyses.Results: The subtheme on the motivation to seek IM service was analyzed, covering the perceived limitation of ConM effect, perceived benefits of IM service, and assessment of IM effectiveness. Patients expected IM service to retard disease progression, stabilize concomitant drug dosage, and reduce potential side effects associated with ConM. In the systematic review, 25 studies from six countries were included covering CM, Korean medicine, Ayurvedic medicine, and western herbal medicine. Existing study designs did not include a detailed assessment of concomitant drug change and adverse events. Majority of studies either recruited a non-representative proportion of patients as traditional, complementary, and integrative medicine (TCIM) diagnosis was used as inclusion criteria, or not reflecting the real-world practice of TCIM by completely dropping TCIM diagnosis in the trial design. Consultation follow-up frequency is the least pragmatic domain. Increase in pragmatism did not associate with a higher risk of bias.Conclusion: Existing IM pragmatic trial design does not match the patients' expectation in the analysis of incident concomitant drug change and adverse events. A two-layer design incorporating TCIM diagnosis as a stratification factor maximizes the generalizability of evidence and real-world translation of both ConM and TCIM.

show abstract

Does evidence based medicine adversely affect clinical judgment?

Abstract: For practical and theoretical reasons, says Michel Accad, evidence based medicine is flawed and leads to standardised rather than excellent individualised care, but Darrel Francis argues that it protects patients from seemingly rational actions that cause more harm than good

Cited by 25 publications

References 15 publications

Clinical Audits in Chronic Obstructive Pulmonary Disease: what for?

Clinical Audits in Chronic Obstructive Pulmonary Disease: what for?

The Emperor's New Clothes: a Critical Appraisal of Evidence-based Medicine

PRAgmatic Clinical Trial Design of Integrative MediCinE (PRACTICE): A Focus Group Series and Systematic Review on Trials of Diabetes and Kidney Disease

Contact Info

Product

Resources

About