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EBM begins, ends with patient in mind
by Dick
Peterson
Public
Relations
As medical practice develops, buzzwords pop up like mile markers on a
highway: Information overload, lifelong learning, evidence-based
medicine. Whoa! Let’s back up and take a look at that last one.
Evidence-based medicine? “It’s an important movement in medicine,
allied health, social science and the humanities,” said the MUSC
reference librarian Laura Cousineau. “Even other disciplines are
adopting evidence-based processes and adapting them outside the realm
of health care. Many MUSC departments, faculty, and clinicians are
actively studying the process of evidence-based medicine now, and
looking for ways to incorporate it in their teaching and in their
practice.”
With evidence-based medicine, the clinician considers what is best for
the patient, based on a thorough clinical evaluation, the patient’s
values, and on what the evidence reveals. Contrary to the stereotype of
rigidly applying the results of studies, evidence-base practice demands
that the process begins and ends with the patient, and that the patient
be a part of the decision-making. The clinician must have the ability
to formulate an appropriate clinical question, search the medical
literature for the best level of evidence, and evaluate the strength of
that evidence and its applicability to the individual
patient.
It stands to reason that if medical practice is to be based on
evidence, as the buzzword suggests, then that evidence must be readily
available. And that’s what puts the library and its information
retrieval resources at the center of the movement.
Cousineau explained that clinicians who practice evidence-based
medicine explore beyond standards of care taught in medical school.
They also consult the latest medical literature to read results of
systematic reviews, randomized controlled trials, and cohort studies,
to apply findings that are best for their individual patient.
Until recently, evidence-based medicine was a nice thought, but too
cumbersome to practice. A clinician with a dozen patients in the
waiting room, a couple more waiting in exam rooms and one being
examined, hasn’t the time to pull journals off a shelf in the Library.
To bring it a bit more up-to-date, there’s not even time to turn to a
computer and explore the Internet Web sites of related disciplines.
“The library has arranged its information resources so that those that
are evidence-based can be easily identified. (See
http://www.library.musc.edu/ebm/.) “Some are pre-evaluated,”
Cousineau, said, which means they can be quickly consulted, even at the
patient’s bedside. But in other situations, when more time is
available, a more thorough search of the literature is necessary. For
these situations, the library offers classes, workshops, presentations
and individual consultations to help clinicians learn to search the
literature in an effective and efficient manner. She explained
that in a typical evidence-based medicine situation, the clinician
would conduct an exam, take a history and formulate a question. Once
the evidence is found and evaluated, it’s back to the patient with a
treatment based on the patient’s cultural values, financial situation
and medical needs.
“We’re hoping to make the process easier, the search for information
more effective, and search time more efficient,” Cousineau said. A
clinician conducting an evidence-based search might find a systematic
review of evidence from the Cochrane Library or CINAHL, a randomized
control trial in PubMed to identify best treatment, identify in Medline
a study testing a new diagnostic tool, or a prospective cohort study
for prognosis evidence.
The library’s effort to spread the word about evidence-based medicine
also extends to student education. Bob Poyer, who is assistant director
of the library for public services and education, said that
students “including physician assistants and physical therapists”
at MUSC are leaving here knowing how to find the evidence they will
need. “It’s becoming a part of the curriculum.”
Friday, July 15, 2005
Catalyst Online is published weekly,
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