Evidenced Based Medicine

[Dr. J?]

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Question for all of you out in the trenches...

How often do you use EBM? At my school we are currently being beat over the head with pre-test probabilities, pre-test odds, PV+, LR+, ERR, ARR, NNT, etc. I guess my question is whether these things are figured at the bedside for daily decisions or whether they are used more in the establishment of treatment protocols?

 

[pikachu]

On the other hand, EBM shouldn't just be reduced to calculating all these statistics for any given patient - it's also asking the simple question "Does the existing literature support my decision?" I would feel much more comfortable in recommending a therapy if there are good (randomized controlled) trials to back it up. And, no math, just familiarity with the literature or a willingness to look for trials that substantiate your decision making. Granted there aren't RCT's or meta-analysis available for everything (or perhaps even most things), but if the information is available from clinical trials, I think it should be used.

 

[pikachu]

This is true to a point - guidelines are definitely much more efficient than trying to review the whole body of literature on a certain subject. I still feel that it's important to be able to critically evaluate a paper on your own as well as to evaluate the literature if there are no guidelines available.

 

[SLUsagar]

Question for all of you out in the trenches...

How often do you use EBM? At my school we are currently being beat over the head with pre-test probabilities, pre-test odds, PV+, LR+, ERR, ARR, NNT, etc. I guess my question is whether these things are figured at the bedside for daily decisions or whether they are used more in the establishment of treatment protocols?

if EBM means copying and pasting uptodate, then yah, tons of people use it....

 

[cytoborg]

Question for all of you out in the trenches...

How often do you use EBM? At my school we are currently being beat over the head with pre-test probabilities, pre-test odds, PV+, LR+, ERR, ARR, NNT, etc. I guess my question is whether these things are figured at the bedside for daily decisions or whether they are used more in the establishment of treatment protocols?

My institution is really into it, too. It's especially funny to see residents get into pissing contests in front of the attending..."Well in clinical trial X they showed a NNT of Y..." "Well that study was clearly underpowered, and if you look closely they didn't even control for Z..." "Well clinical trial A had B number of participants making it the largest multicenter trial to date and showed a relative risk reduction of C..." But I think EBM is a good thing. Half of clinical medicine is voodoo...we should be doing what works.

 

[Dr. J?]

Flindophile,

That's interesting that you used to teach decisional analysis...what type of students were you teaching?

 

[Dr. J?]

For everyone,

In your experiences, what percentage of clinical decisions are made based upon personal clinical experience, EBM, or tradition?

Also, were all the rest of you introduced to EBM in your pre-clinical years?