Ethics and evidence based surgery

Abstract

Traditionally, surgical practice has been experiential and based on the contemporary understanding of basic mechanisms of disease. It was both a science and an art and depended to far too great an extent on the individualism and self belief of its main exponents. “Evidence based medicine” (EBM) emerged in the 1980s and a new gospel of “Rules of Evidence” was introduced. There is no doubt that the net effect of EBM has been beneficial, but over reliance on randomised controlled trials and the lack of generalisability of scientific evidence to individual patients has perhaps led to less enthusiasm for its tenets among surgeons. There are valid and spurious reasons for this that are discussed. The situation is improving but inevitable tensions remain between the surgeon committed to the individual patient here and now, and the clinical researcher whose focus is the benefit of future patients in the larger community.

Management of odontogenic keratocysts of the jaws: A ten-year experience with 120 consecutive lesions

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Clinical Pathways in surgery—should we introduce them into clinical routine? A review article

“…Lastly, treatment decisions in surgery are even nowadays often based on personal experience of the treating physician rather than on actual evidence-based treatment standards. This is a situation which potentially contrasts with the ideal of standardised care desired under both economic and quality aspects [4][5][6].…”

Evidence-based surgery – evidence from survey and citation analysis in orthopaedic surgery

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