Link: Ad libitum.

Resistance to Evidence-Based Medicine
Lately I have been encountering (or noticing more) a reluctance on the part of many physicians to accepting that evidence based medicine is a good thing. Theres quite a bit written about this. Physicians are resistant to accepting EBM for several reasons:
1. Many feel threatened that with EBM they will not be allowed to practice the way they want to practice – most physicians have a strong sense of autonomy.
2. They may feel that EBM is a tool that others will use to enforce ‘recipes’ on how to practice medicine (the “It’s cookbook medicine” argument).
3. Some feel that each patient encounter is unique and only the physician is able to judge in that particular context what the best treatment is for his patient.
4. Many docs are unfamiliar with the concepts and skills required to practice EBM. This leads to fear of the unknown, which is one of the strongest fears anyone can have.
5. Misconceptions about the nature of EBM are common.
6. Most physicians do not have the time to devote to searching and appraising the literature.
7. Patients do not demand that their doctor practices according the evidence and not just based on opinion, habit or out-dated information.
8. The “medicine is an art, not a science” argument.

# posted by LMF @ 11:39 PM 0 comments
Monday, June 20, 2005

Essential Tools for EBM
I had previously listed two essential tools to practice evidence based medicine:
1. A healthy sense of skepticism.
2. An understanding of the concept of probability.

Here are some more:
3. A belief that systematic observation yields the truth more reliably than unsystematic, anecdotal observation.
4. An ability to deal with, and live with uncertainty.
5. A willingness to accept that the current basis for your practice may be false.
6. Acceptance that given the same medical facts, the appropriate decision may vary, depending on how the patient values different outcomes.
7. Willingness to question authority. Experts (even renowned ones) may be wrong.
8. Honesty with oneself about one’s own biases.

A couple of good posts from a MD blog that is dedicated to EBM with a slant towards pediatrics and neonatology. has a few good jokes as well!

Larry