Evidence-based medicine-the decline of authoritarian medicine

ABSTRACT

Evidence-based medicine according to a British Medical Journal, 'Remains a hot topic for clinicians, public health practitioners, purchasers, planners and the public...and has become a common topic in the lay media'. An understanding of evidence-based medicine requires first of all an appreciation of classical medical practice, because evidence-based medicine represents a clear shift, in focus and orientation for student, teacher and practitioner of medicine alike. The classical medical practice paradigm according to an editorial in the Postgraduate Medical Journal requires doctors to identify the problem, use their experience, ask a trusted colleague, consult a reference text, or read a review. The same journal, says that the evidence-based approach - the new paradigm - requires doctors to formulate an appropriate clinical question, conduct a literature search, select the key articles, critically appraise the articles, and then apply the results of the search to the patient. This new emphasis on the use of medical literature in the provision of care is considered to be so fundamental as to constitute a paradigm shift. The evidence-based approach de-emphasizes intuition, and puts a much lower value on authority but does not reject it, since it recognizes that there are exceptional clinicians who have a gift for intuitive diagnosis and precise observation. It asserts, however, that systematic recording of observations in a reproducible and unbiased fashion will increase the confidence levels about knowledge of diagnosis, prognosis and efficacy of treatment, and further that an understanding of disease and physiological processes, while important, is insufficient as a guide for clinical practice (AU)