Evidence-based Practice in Primary Care
Editors: Chris Silagy and Andrew Haines
"Did you know that wearing an underwired bra causes breast cancer?" , asked my 14 year old daughter. That casual remark over the breakfast table set me thinking about evidence-based medicine (EBM). "Who says so?", I asked her. "Laura told me", she replied. I explained that we needed a larger evidence base than her school friend and I was going to try and find the evidence to confirm or refute her statement. Which brings me neatly to the subject of this small but comprehensive book.
Consider for a moment how you treat an acute otitis media. Do you prescribe antibiotics? If so, which one and for how long? Do you know how many attacks would have subsided on no treatment and how many patients may be harmed by your treatment? In short, is there evidence to back up your approach? If your treatment fails and the patient deteriorates, can you defend yourself? How many treatments that are regarded as standard actually have an evidence base?
This interesting and thought provoking text aims to explore many of these imponderables and to set the jobbing GP off on the road to sound evidence-based practice. Early on in the book, we learn how to set priorities - only important and relevant issues merit consideration. Asking the right question helps us in the next stage of tracking down the evidence. Once we have found what we’re looking for, it should be critically appraised. Chapter 4 explains how this might be achieved and Chapter 5 shows the way to put it into practice with patients. The remainder of the book is devoted to the issue of fostering an "EBM atmosphere" in one’s own practice.
There are many barriers to adopting an evidence-based approach to our work and box 12.3 illustrates why practitioners may be slow to embrace the concept of evidence-based medicine (EBM) - not least because of lack of time and resources. However, the inescapable conclusion is that EBM is definitely here to stay so we’d better get to grips with it.
Oh yes, the underwired bra thing....Professor Gordon McVie, director general of the Cancer Research Campaign, said on 30.10.2000: "There is no substantiated evidence to link wearing a bra to breast cancer" ....beat that for quality evidence, Laura.
| Publisher: | BMJ Books
|
|---|
| 2nd Edition
|
| ISBN: 0-72-791568-1
|
| Contact: | BMJ Books, PO Box 295, London. WC1H 9TE
|
|---|
| Reviewer: | Dr Jeremy M Sager
|
|---|
| Month of review: | September 2001
|
|---|
