Session 2 - Evidence Based Medicine

Question 1

Pros of EBP

Answer 1

• effective

- cost effective

Question 2

Why have systematic reviews?

Answer 2

• Personal narratives may be bias and subjective helps prevent bias decisions
• Highlights gaps in research
• It was difficult to see how studies were identifies in review articles
• Easy for doctors to assess the evidence
• Relatively easy to convert into guidelines

Question 3

Why are systematic reviews useful to clinicians?

Answer 3

• Save them having to go out and look at all the individual pieces of evidence
• Offer quality control and increased certainty
• Can be converted into guidelines
• Give up to date conclusion

Question 4

Give some philosophical criticisms to EBP

Answer 4

• Creation of unreflective rule followers (loss of clinical judgement)
• Does not take into account patient choice
• May work for the population but no the patient in front of you
• May be though of a way of legitimising rationing and have a negative impact on the doctor patient relationship

Question 5

Give some practical criticisms of EBP

Answer 5

• Hospitals may not have the resources to implement the change
• RCT’s gold standards but may not be ethical
• Trust in the pharmaceutical companies
• Almost impossible task of making everything into a guideline and reviewing all the evidence
• systemic reviews for all specialities difficult to do

Question 6

Why is it difficult implementing EBP?

Answer 6

• Doctors may not know the evidence even exists (take time out of seeing patients to keep up to date)
• Hospitals may not have resources to implement a change (financial costs)
• Doctors may know about the evidence but do not implement it due to habit or professional judgement

Question 7

How did we get to evidence based practice?

Answer 7

1) inappropriate and ineffective use of resourses
2) variations in treatment lead to inequalities
3) clinical practice dictated by clinical fashion, professional opinion
4) huge variations in practice