Research and EBM - John Murtagh

The process of EBM should be very confortable for GPs because scientific methodology and evidence is second nature to us and has been the basis of our clinical decision making prior to and subsequent to graduation. The proposed five steps of EBM are similar to basic research methodology. .....

GPs have a responsibility to their patients to be well versed with the best evidence when making decisions about management, whether it be for minor surgical procedures, selection of drugs, selection of an investigation or referral to the most appropriate consultant. If the best evidence reveals that a certain practice we are using is of no value or there may be more efficacious method to our favoured method, then we should be prepared to change. On the other hand, if we find that a certain method works for us and there is no current method that works for us and there is no current evidence that it is the most appropriate one or the evidence is equivocal, then there is no compelling reaosn to change.

GPs need a healthy scepticism about what is best evidence and claims for treatment in addition to the skill of critical appraisal of research/evidence. We tend to be impressed by the perception that evidence is a numbers game.

For evidence to be accepted by GPs, the information needs to be readily accessible, user friendly, significant, relevant and perhaps believable.

The strength of EBM is that it can provide the answers to very important everyday decisions, especially in screening and preventive medicine, where guidelines have fluctuated over the decades. The recent RACGP guidlines for preventive activities in general practice highlight the value of current evidence.

John Murtagh. General Practice. 3rd edition Page 137-140