A PERSPECTIVE OF EVIDENCE-BASED MEDICINE

Evidence based-medicine (EBM), as currently known, emerged from team work at McMaster University in Canada in the eighties, and the concept is credited to Dr. David Sackett and Dr. Gordon Guyatt. According to one of the originators of the idea, evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.1 Another definition states that evidence-based medicine is the integration of best research evidence with clinical expertise and patient values. Much of that, of course, was founded on the original ideas enunciated by Archie Cochrane, a Scottish epidemiologist after whom the Cochrane Collaboration and Library, a veritable repository of clinical evidence, was named. A parallel can be drawn here with the other situation where another Scot, Dr. Ronald Harden had pioneered one of the major advancements in examination procedure, the Objective Structured Clinical Examination (OSCE), his invention having also burgeoned in parts of North America before receiving world-wide recognition. These definitions of EBM not only reveal its very inclusive nature, but indeed emphasise the aspect of individuality. In that regard, EBM is now standard practice in many countries and institutions, and firmly established in curricula, guidelines and operating procedures. There is evidence though that physicians’ perceptions, knowledge and practice of EBM differ widely.2