| A. |
|
Positive about EBM - useful in clinical decision, meeting
information needs |
| |
1. |
"For family medicine, I think that we now have something
to base our approaches on rather than just sort of general nice feelings.
We have a more organized way, particularly from a teaching point of
view, of how to approach problems . . . . I think [EBM] is probably
the only way to go now, given that we have access to such a mountain
of information".12 |
| |
2. |
We do need a lot of evidence-based medicine at our finger
tips to discuss issues with patients, particularly with preventive
health care and education. Sometimes we have to act as teachers as
much as doctors, and if we've got a few pertinent figures to quote
that helps enormously. . . ".8 |
| |
3. |
. . . if you've got the meta-analysis you sort of have
a reasonable amount of faith that these guys have enough of an idea
of how to conduct research and how to analyze and you say perhaps
I can believe that".8 |
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|
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| B. |
Devaluation of "the art of medicine" |
| |
1. |
"In terms of the art of medicine, you can imagine
how patients would feel if you said, "you've got such and such
. . . now let's review the evidence", and you completely ignore
their feelings and everything else".8 |
| |
2. |
"Evidence-based medicine seems to be a word that
has become very fashionable, and in many ways, I wonder how it is
different than the medicine that I learned 30 years ago. To me, it
means that there is evidence to show that something is effective and
I thought that that's what we did all along . . . . I haven't seen
anything in it that convinces me that it's a huge paradigm shift".12
|
| |
3. |
"Yes, I think there's two types of evidence; there's
the evidence that you pick up from journals and books and lectures
and compact disks and all that sort of thing and there's the evidence
that you acquire from 15-20 years hands on experience with patients.
I think however much you read or research what other people's experience
is, your own experience in the long term is what guides you to make
the decisions you make".8 |
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|
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| C. |
Difficulty in implementing evidence because
of patient and practice factors |
| |
1. |
"A lot of times the findings of these large clinical
trials are indiscriminately applied to a population that it doesn't
apply to. I'm very critical of that. I'm sort of on hyper-alert for
not doing that . . . . I wouldn't want to be treated exactly the same
way as 10 million other people simply because for 90 percent of people
this works. What if I'm one of the other 10 percent?".12
|
| |
2. |
"Evidence might be that if you've got breast cancer
you do such and such, but some patients, for whatever reasons, it
might be that they have some other illness or they're 90 or they've
got religious reasons or . . . . it doesn't matter what the evidence
says, it's just not the right thing for that person . . .".8
|
| |
3. |
"What we practice is too rich and too densely textured
to be able to sort out a few threads and say that's evidence-based
and pure science . . . you can do that . . . in a coronary care unit
or somebody who is a physiological preparation in intensive care .
. . . You can't do that in their lounge room . . . you know, surrounded
by cats and dogs and wheezy children . . . (laughter) . . . You know
it's not the same!".8 |
| |
4. |
"Well, the kind of patients I deal with . . . . I
have a lot of country people in my practice and a fair number of geriatrics
. . . [and] a lot of them don't seem to want the evidence".14 |
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|
|
| D. |
Uncertainty in quality of evidence
|
| |
1. |
"And on the other side of things, there's the drug
companies but there's also the government types, you know . . . .
If they're recommending amoxicillin for pneumonia, you don't know
if they're doing it because it's a really good idea or because that's
cheap, you know".8 |
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|
|
| E. |
Lack of relevant evidence |
| |
1. |
" . . . if you just look at all the jolly coughs
and colds that GPs see. I mean, whether you should use antibiotics
in these sort of situations, I mean there's no sort of evidence for
these sort of situations, whether you should use all these other sort
of symptomatic relief things or whether you should use a cough suppressant
or not?! Laughter . . . ".8 |
| |
2. |
" . . . and if you should happen to be aware of the
evidence being poorer for certain types of management then you should
probably include your reservations in any recommendation for management".8 |