Muir Gray regarded this definition as too doctor-centric and expanded it to emphasize the importance of the patient perspective and proposed that, “ …evidence based clinical practice is an approach to decision making in which the clinician uses the best scientific evidence available, in consultation with the patient, to decide upon the option which suits the patient best.”. The practice of evidence-based medicine means integrating individual clinical experience with the best available external clinical evidence from systematic research”. It is framed as “ …the conscientious, explicit and judicious use of best evidence in making decisions about the care of individual patients.
Over the past 20 years or more, the concept of evidence-based medicine (EBM) has increasingly been accepted as the gold standard for decision making in medical/health practice and policy.ĮBM provides a standard procedure for using evidence in clinical decision making. an interconnected, non-linear phenomenon that may be better analysed using a variety of complexity science techniques. ConclusionĮBM needs to move forward and perceive health and healthcare as a complex interaction, i.e. This method can be useful in the phase of discovery but is inadequate in the field of implementation, which needs to incorporate additional information including expert knowledge, patients’ values and the context. As a corollary, the preferred method for generating evidence is the explanatory randomized controlled trial. The main problem with the EBM approach is the restricted and simplistic approach to scientific knowledge, which prioritizes internal validity as the major quality of the studies to be included in clinical guidelines.
It was quickly adopted on the basis of authoritative knowledge rather than evidence of its own capacity to improve the efficiency and equity of health systems. The need for standardization, the development of clinical epidemiology, concerns about the economic sustainability of health systems and increasing numbers of clinical trials, together with the increase in the computer’s ability to handle large amounts of data, have paved the way for the development of the EBM movement. Our analysis utilizes two frameworks: (1) a complex adaptive view of health that sees both health and healthcare as non-linear phenomena emerging from their different components and (2) the unified approach to the philosophy of science that provides a new background for understanding the differences between the phases of discovery, corroboration, and implementation in science. This paper aims to describe the contextual factors that gave rise to evidence-based medicine (EBM), as well as its controversies and limitations in the current health context.
0 kommentar(er)
