We all know about EBM or evidence based medicine. Past decade has seen a steady rise in the use of EBM when doctors make decision about patients. The EBM and through its use, the care provision is supposed to be more appropriate as well as research based and scientific. The three pillars of the EBM are following.
- Established scientific knowledge called evidence, it relates to the problem the patient is seeing health care person about.
- Experience of the treating physician.
- The patient’s choices or apprehensions.
This makes EBM a suitable combinations of doctor patient combined decision making within the norms of scientific evidence while understanding and respecting patient’s sensitivities, and apprehensions.
The emergency department poses a challenge to EBM, as due to time sensitive care, it may be tough to benefit from any sort of documented evidence while treating the patients. Furthermore, it becomes another challenge to adequately communicate and incorporate the patient’s choices, expectations and religious or other sensitivities. At times the patients may not be the decision maker thus adding a layer of difficulty at times to practice EMB through interpreter / surrogate or proxy.
It is also imperative to use appropriate research question or decision making to provide justice to the patient. Treating doctor need to realize if the evidence has the capability to be generalized enough to help my patient. This is where it is felt that patient care should be done based upon evidence that is appropriate, and it is quite important to realize the value of right evidence and that can only come when local researchers will do research to benefit local patients. We also know that this requires doing research on local population and publishing it to benefit us all. In order to create an appropriate evidence then either we need to collaborate with each other, or we should be able to pool published studies. When it comes to LMIC (low and middle income Countries), It has been observed that the evidence creation is not a priority for various reason. The most important reason is actually the will or ownership of people providing care and secondly, trust that the data will be safe once if leaves institutions. Once we sort out these obstacles and find the ways to collaborate and also pool data, then we will be able to generate patient’s data which will be meaningful. We should keep this in mind that the bigger data or the larger size of patient pool increases the quality of the evidence. It means we need increased number and more relevant and accurate observation translating into meaningful evidence. Based upon these evidences our care will be more targeted and will bear better results.
My feeling is that we need to build the trust between different institutions to be able to pool data or do collaborative research. This is the first but most important step and will further lead us all into evidence creation. I also am hopeful that advance in technology will help pave the way to decision support system. I will write about that in very near feature.
I am very optimistic and hopeful to see that day when we will treat our patients as per our own evidence and our own sensibilities and limitations. That day will be the day of Evidence Based Medicine in Pakistan.