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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, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.